Healthcare Provider Details

I. General information

NPI: 1104757806
Provider Name (Legal Business Name): MELISSA DAWN KEMPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 WARRIOR DR
VINCENT OH
45784-5036
US

IV. Provider business mailing address

60 WARRIOR DR
VINCENT OH
45784-5036
US

V. Phone/Fax

Practice location:
  • Phone: 740-678-2395
  • Fax: 740-445-5301
Mailing address:
  • Phone: 740-678-2395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.314541
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: