Healthcare Provider Details

I. General information

NPI: 1366926156
Provider Name (Legal Business Name): KIM FLORENCE KEKEL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 STOW RD
STOW OH
44224-1844
US

IV. Provider business mailing address

3743 COMPTON CT
STOW OH
44224-5450
US

V. Phone/Fax

Practice location:
  • Phone: 330-689-5450
  • Fax:
Mailing address:
  • Phone: 330-780-6485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN.251143
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: