Individual
KIMBERLEY DAWN WILSON-KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
STNA
Contact information
Practice address
914 HENRY ST, MASURY, OH 44438-1217
(330) 979-9194
(330) 619-5502
Mailing address
914 HENRY ST, MASURY, OH 44438-1217
(330) 979-9194
(330) 619-5502
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
0134249
OH
376K00000X
Nurse's Aide
10077943
PA
376K00000X
Nurse's Aide
401638710414
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0134240
INDEPENDENT PROVIDOR
OH
01
—
10077943
CNA
PA
01
—
401638710414
STNA
OH
Enumeration date
06/22/2016
Last updated
06/22/2016
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