Provider Demographics
NPI:1093556359
Name:KALLON, ANNETTE BAKIE
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:BAKIE
Last Name:KALLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3880 WHITE POND DR APT 102
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-3993
Mailing Address - Country:US
Mailing Address - Phone:803-440-7422
Mailing Address - Fax:
Practice Address - Street 1:3880 WHITE POND DR APT 102
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-3993
Practice Address - Country:US
Practice Address - Phone:803-440-7422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSU625686172A00000X
174200000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty
No174200000XOther Service ProvidersMeals