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NPI Code Detail

MEDICARE: DR. GINA MARIE KICOS DNP, APRN-CNP

MEDICARE: DR. GINA MARIE KICOS DNP, APRN-CNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAPRN.CNP.14603OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073952685
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GINA MARIE KICOS DNP, APRN-CNP
Provider Business Mailing Address
First Line : 3721 20TH ST NW
Second Line :
City : CANTON
State : OH
Zip : 44708-2926
Country : US
Telephone Number : 330-354-7324
Fax Number :
Provider Business Practice Location Address
First Line : 4235 TUSCARAWAS ST W
Second Line :
City : CANTON
State : OH
Zip : 44708-5424
Country : US
Telephone Number : 234-203-4232
Fax Number : 330-266-4386
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2013
Last Update Date : 07/14/2023

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