Healthcare Provider Details

I. General information

NPI: 1588910418
Provider Name (Legal Business Name): KYRA PACER PMHCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10524 EUCLID AVE
CLEVELAND OH
44106-2205
US

IV. Provider business mailing address

10524 EUCLID AVE
CLEVELAND OH
44106-2205
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-2400
  • Fax: 216-844-1703
Mailing address:
  • Phone: 216-844-2400
  • Fax: 216-844-1703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0813X
TaxonomyGeropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN.CNS.13363
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: