Provider Demographics
NPI:1306606264
Name:GOINES, KAYLYNN JO (CNAHHADSP)
Entity type:Individual
Prefix:
First Name:KAYLYNN
Middle Name:JO
Last Name:GOINES
Suffix:
Gender:F
Credentials:CNAHHADSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 12TH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-4536
Mailing Address - Country:US
Mailing Address - Phone:740-352-1560
Mailing Address - Fax:
Practice Address - Street 1:1618 12TH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4536
Practice Address - Country:US
Practice Address - Phone:740-352-1560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide