Healthcare Provider Details

I. General information

NPI: 1285366930
Provider Name (Legal Business Name): KESCHA SIMS STNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3923 GRAND AVE
CINCINNATI OH
45236-3909
US

IV. Provider business mailing address

3923 GRAND AVE
CINCINNATI OH
45236-3909
US

V. Phone/Fax

Practice location:
  • Phone: 513-888-6484
  • Fax:
Mailing address:
  • Phone: 513-888-6484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: