KIMBERLY CAROL VANDALEN NPI 1053784009

NPI Information

NPI: 1053784009
Provider Name: KIMBERLY CAROL VANDALEN
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
193 S PROGRESS DR
XENIA, OH
ZIP 45385
Phone: (937) 372-7583
Get Directions

Kimberly Carol Vandalen is a family nurse practitioner in Xenia, OH. Kimberly Carol Vandalen NPI is 1053784009. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

193 S PROGRESS DR
XENIA, OH
ZIP 45385-673
Phone: (937) 372-7583

The NPI 1053784009 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 11/12/2015 and was last updated on 10/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207Q00000X	Family Medicine		AP129610	TEXAS	No
2	2083P0901X	Preventive Medicine	Public Health & General Preventive Medicine	AP129610	TEXAS	No
3	208D00000X	General Practice		AP129610	TEXAS	No
4	363LF0000X	Nurse Practitioner	Family	APRN.CNP.025839	OHIO	Yes
5	363LF0000X	Nurse Practitioner	Family	AP129610	TEXAS	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	87V600	OTHER	TEXAS	BCBS
2	AP129610	OTHER	TEXAS	TEXAS STATE LICENSE
3	063389301	MEDICAID	TEXAS
4	083850001	MEDICAID	TEXAS
5	0389946	MEDICAID	OHIO
6	017801401	MEDICAID	TEXAS
7	87V601	OTHER	TEXAS	BCBS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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