Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | COA-14823-NP | OH |
NPI | 1003258773 |
---|---|
Provider Name | Kimberly Kay Myers |
First Address | Dayton, OH 45459-4296 |
Second Address | Dayton, OH 45459-4296 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2013 |
Last Update Date | 24/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110086 | (05) | OH |