Healthcare Provider Details

I. General information

NPI: 1316488810
Provider Name (Legal Business Name): KENNETH GILBERT LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2017
Last Update Date: 01/16/2025
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2549 VILLA SAVOIRE
COLUMBUS OH
43219-3198
US

IV. Provider business mailing address

2549 VILLA SAVOIRE
COLUMBUS OH
43219-3198
US

V. Phone/Fax

Practice location:
  • Phone: 614-738-8983
  • Fax:
Mailing address:
  • Phone: 614-738-8983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.136347.MEDS-IV
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: