Basic Information
| Provider Information | |||||||||
| NPI: | 1649314170 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EBERST | ||||||||
| FirstName: | KIMBERLY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3689 WATT RD | ||||||||
| Address2: | |||||||||
| City: | GAHANNA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432301158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145072622 | ||||||||
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| Practice Location | |||||||||
| Address1: | 299 CRAMER CREEK CT. | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148895722 | ||||||||
| FaxNumber: | 6148899335 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | PENDING | OH | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.