Healthcare Provider Details

I. General information

NPI: 1457270746
Provider Name (Legal Business Name): EBONY KIDD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11427 REED HARTMAN HWY
BLUE ASH OH
45241-2418
US

IV. Provider business mailing address

11427 REED HARTMAN HWY
BLUE ASH OH
45241-2418
US

V. Phone/Fax

Practice location:
  • Phone: 513-374-9523
  • Fax:
Mailing address:
  • Phone: 513-374-9523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.186152
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: