Healthcare Provider Details

I. General information

NPI: 1255255998
Provider Name (Legal Business Name): KLD55 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 E WARREN ST
CADIZ OH
43907-1172
US

IV. Provider business mailing address

71778 SUNNY ACRES DR
MARTINS FERRY OH
43935-2372
US

V. Phone/Fax

Practice location:
  • Phone: 740-672-5785
  • Fax: 740-320-4012
Mailing address:
  • Phone: 740-238-3688
  • Fax: 740-238-3688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: KRISTY DOBSON
Title or Position: NURSE PRACTITIONER
Credential: NP-C
Phone: 740-238-3688