Provider Demographics
NPI:1285982306
Name:ANDERSON, KAMEKA YVONNE (CNP)
Entity type:Individual
Prefix:MRS
First Name:KAMEKA
Middle Name:YVONNE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MS
Other - First Name:KAMEKA
Other - Middle Name:YVONNE
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:329 N WEST ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4332
Mailing Address - Country:US
Mailing Address - Phone:419-221-3072
Mailing Address - Fax:419-481-9895
Practice Address - Street 1:2400 COLLINGWOOD BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43620-1152
Practice Address - Country:US
Practice Address - Phone:419-841-1832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH299832163W00000X
OHCOA.15595-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse