Healthcare Provider Details

I. General information

NPI: 1528380276
Provider Name (Legal Business Name): REBECCA JOSEPHINE KIKO CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SIXTH ST SW STE 800
CANTON OH
44710-1702
US

IV. Provider business mailing address

5440 ESHELMAN ST
LOUISVILLE OH
44641-8545
US

V. Phone/Fax

Practice location:
  • Phone: 330-363-1342
  • Fax:
Mailing address:
  • Phone: 330-875-6840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberRN.267125-COA1
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: