Healthcare Provider Details

I. General information

NPI: 1205871985
Provider Name (Legal Business Name): KENT STATE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 04/25/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 EASTWAY DR
KENT OH
44242-0001
US

IV. Provider business mailing address

1500 EASTWAY DRIVE
KENT OH
44242-0001
US

V. Phone/Fax

Practice location:
  • Phone: 330-672-8194
  • Fax: 330-672-2272
Mailing address:
  • Phone: 330-672-8245
  • Fax: 330-672-3711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CESQUINN J CURTIS
Title or Position: ASSOCIATE VICE PRESIDENT, STUDENT A
Credential:
Phone: 330-672-1007