Provider Demographics
NPI:1073854642
Name:KIRKSEY, CORY R (LPN)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:R
Last Name:KIRKSEY
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 RYE BEACH RD APT 1B
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-1187
Mailing Address - Country:US
Mailing Address - Phone:440-447-7041
Mailing Address - Fax:
Practice Address - Street 1:221 RYE BEACH RD APT 1B
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:OH
Practice Address - Zip Code:44839-1187
Practice Address - Country:US
Practice Address - Phone:440-447-7041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.149378-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse