Healthcare Provider Details

I. General information

NPI: 1922723667
Provider Name (Legal Business Name): KATIE RARDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 10/05/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1927 PROVINCETOWN RD
DAYTON OH
45459-3439
US

IV. Provider business mailing address

1927 PROVINCETOWN RD
DAYTON OH
45459-3439
US

V. Phone/Fax

Practice location:
  • Phone: 937-867-9099
  • Fax:
Mailing address:
  • Phone: 937-867-9099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: