1033363544 NPI number — MR. KENNETH TODD KIRKSEY LISW-S, CEAP

Table of content: MR. KENNETH TODD KIRKSEY LISW-S, CEAP (NPI 1033363544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033363544 NPI number — MR. KENNETH TODD KIRKSEY LISW-S, CEAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIRKSEY
Provider First Name:
KENNETH
Provider Middle Name:
TODD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LISW-S, CEAP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033363544
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REYNOLDSBURG
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43068-6600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-582-1835
Provider Business Mailing Address Fax Number:
614-837-0112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 W COLUMBUS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PICKERINGTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43147-1256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-837-0063
Provider Business Practice Location Address Fax Number:
614-837-0112
Provider Enumeration Date:
11/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  I. 0008323SUPV , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com