MEDICARE: KAY KIRKSEY BSN, 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
1	163WG0000X	General Practice Registered Nurse	RN.3132226	OH

General Provider Information

NPI Number	:	1922770452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAY KIRKSEY BSN, RN

Provider Business Mailing Address
First Line	:	2423 E 82ND ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-2256
Country	:	US
Telephone Number	:	216-507-3498
Fax Number	:

Provider Business Practice Location Address
First Line	:	2423 E 82ND ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-2256
Country	:	US
Telephone Number	:	216-507-3498
Fax Number	:

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

Provider Enumeration Date	:	10/04/2021
Last Update Date	:	12/22/2021

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