Healthcare Provider Details

I. General information

NPI: 1649878406
Provider Name (Legal Business Name): KIM E HAYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 10/14/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7618 ROSS RD
OREGONIA OH
45054-9720
US

IV. Provider business mailing address

7618 ROSS RD
OREGONIA OH
45054-9720
US

V. Phone/Fax

Practice location:
  • Phone: 937-623-6018
  • Fax:
Mailing address:
  • Phone: 937-623-6018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: