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General NPI Number Information
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NPI Number | 1770492993
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Entity Type | Individual
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Provider Name | IVY KEMP
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Gender | Female
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Dates
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Enumeration Date | 09/03/2026
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Last Update Date | 09/03/2026
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Provider Practice Location Address
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Address Line | 7058 CORPORATE WAY STE 3
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City | DAYTON
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State | OH
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Zip | 45459-4243
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Country | US
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Telephone | 937-991-0080
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Fax | 937-991-0083
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Provider Business Mailing Address
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Address Line | 2015 27TH ST SE APT 201
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City | SAINT CLOUD
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State | MN
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Zip | 56304-8591
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Country | US
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Telephone | 786-698-0260
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | PRS.003759
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License Number State | OH
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