Healthcare Provider Details

I. General information

NPI: 1194661447
Provider Name (Legal Business Name): IVORY VAIRIENEQUE BYRD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 ASHLAND DR
COVINGTON KY
41015-1088
US

IV. Provider business mailing address

149 ASHLAND DR
COVINGTON KY
41015-1088
US

V. Phone/Fax

Practice location:
  • Phone: 513-834-1951
  • Fax:
Mailing address:
  • Phone: 513-834-1951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number402019811117
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: