Provider Demographics
NPI:1194281832
Name:LEMON, KAILEY LYNAE (CNA)
Entity type:Individual
Prefix:
First Name:KAILEY
Middle Name:LYNAE
Last Name:LEMON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310C MERRITT AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-5020
Mailing Address - Country:US
Mailing Address - Phone:920-203-2455
Mailing Address - Fax:
Practice Address - Street 1:310C MERRITT AVE
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-5020
Practice Address - Country:US
Practice Address - Phone:920-203-2455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty