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NPI Code Detail

MEDICARE: AMBER KELLY BYNUM RN

MEDICARE: AMBER KELLY BYNUM RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN.53024OH

General Provider Information

NPI Number : 1033004015
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMBER KELLY BYNUM RN
Provider Business Mailing Address
First Line : 632 FOLKERTH AVE TRLR 59
Second Line :
City : SIDNEY
State : OH
Zip : 45365-9091
Country : US
Telephone Number : 937-489-9353
Fax Number :
Provider Business Practice Location Address
First Line : 632 WAGNER AVE
Second Line :
City : GREENVILLE
State : OH
Zip : 45331-2649
Country : US
Telephone Number : 937-365-2275
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2025
Last Update Date : 06/11/2025

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