Provider Demographics
NPI:1124484936
Name:THRUSH, KIEYRA IRENE (CNP)
Entity type:Individual
Prefix:
First Name:KIEYRA
Middle Name:IRENE
Last Name:THRUSH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KIEYRA
Other - Middle Name:IRENE
Other - Last Name:MCQUILLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:419-522-3341
Mailing Address - Fax:419-522-1110
Practice Address - Street 1:1029 S TRIMBLE RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-3427
Practice Address - Country:US
Practice Address - Phone:419-522-3341
Practice Address - Fax:419-522-1110
Is Sole Proprietor?:No
Enumeration Date:2016-01-08
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.18480-NP363L00000X
OHCOA18480363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner