Healthcare Provider Details

I. General information

NPI: 1235092917
Provider Name (Legal Business Name): KIA LYNN FARRELL LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 HUNTINGTON PARK DR
COLUMBUS OH
43235-5617
US

IV. Provider business mailing address

PO BOX 751
FOREST RANCH CA
95942-0751
US

V. Phone/Fax

Practice location:
  • Phone: 614-505-0377
  • Fax:
Mailing address:
  • Phone: 530-828-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number727847
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number190915
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: