MEDICARE: MISTY J KLINE

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
1	164W00000X	Licensed Practical Nurse	LPN142300MEDS-IV	OH

General Provider Information

NPI Number	:	1851942254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISTY J KLINE

Provider Business Mailing Address
First Line	:	3018 N MAIN ST
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44903-7823
Country	:	US
Telephone Number	:	419-677-1201
Fax Number	:

Provider Business Practice Location Address
First Line	:	3018 N MAIN ST
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44903-7823
Country	:	US
Telephone Number	:	419-677-1201
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2019
Last Update Date	:	01/11/2023

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Directions to “ MISTY J KLINE ” Practice Location

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