Provider Demographics
NPI:1386939494
Name:BUCHANAN, KATHYLEE (LPN)
Entity type:Individual
Prefix:
First Name:KATHYLEE
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7718 ELMA ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-6226
Mailing Address - Country:US
Mailing Address - Phone:330-858-2787
Mailing Address - Fax:
Practice Address - Street 1:300 BOWMANVILLE ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44305-3349
Practice Address - Country:US
Practice Address - Phone:330-858-2787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2998314374U00000X
OH155748164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2998314Medicaid