Vandalen, Kimberly Carol
Vandalen, Kimberly Carol is an individual health care provider with primary practice located at 193 S Progress Dr , Xenia OH 45385-2673. She recently has 4 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Allopathic & Osteopathic Physicians / Public Health & General Preventive Medicine, Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / General Practice. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Vandalen, Kimberly Carol can be contacted via phone (937) 372-7583.Contact Information
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | APRN.CNP.025839 | Ohio |
| Allopathic & Osteopathic Physicians / Public Health & General Preventive Medicine | 2083P0901X | AP129610 | Texas |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | AP129610 | Texas |
| Allopathic & Osteopathic Physicians / General Practice | 208D00000X | AP129610 | Texas |
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | AP129610 | Texas |
Profile Details
| NPI number | 1053784009 |
|---|---|
| LBN Legal business name | Vandalen, Kimberly Carol |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 12th, 2015 |
| Last updated | Oct 22nd, 2020 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1053784009 | NPPES |
| Ohio | MEDICAID | 0389946 | |
| Ohio | MEDICAID | 083850001 | |
| Ohio | MEDICAID | 017801401 | |
| Ohio | MEDICAID | 063389301 | |
| Ohio | Other | 87V600 | |
| Ohio | Other | 87V601 | |
| Ohio | Other | AP129610 |
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