Healthcare Provider Details

I. General information

NPI: 1114532520
Provider Name (Legal Business Name): MRS. KIMMI SUE GAFFNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7650 WITHERSPOON DR NE
BALTIMORE OH
43105-9712
US

IV. Provider business mailing address

7650 WITHERSPOON DR NE
BALTIMORE OH
43105-9712
US

V. Phone/Fax

Practice location:
  • Phone: 740-407-5546
  • Fax:
Mailing address:
  • Phone: 740-407-5546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number2304965
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: