Provider Demographics
NPI:1386408441
Name:RENFROE, KIRA LATERESE
Entity type:Individual
Prefix:
First Name:KIRA
Middle Name:LATERESE
Last Name:RENFROE
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 1:528 HEATHSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-2121
Mailing Address - Country:US
Mailing Address - Phone:419-509-0153
Mailing Address - Fax:
Practice Address - Street 1:528 HEATHSHIRE DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607-2121
Practice Address - Country:US
Practice Address - Phone:419-509-0153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2910854Medicaid