Provider Demographics
NPI:1427838788
Name:ARTIS, KEVINNETTA
Entity type:Individual
Prefix:
First Name:KEVINNETTA
Middle Name:
Last Name:ARTIS
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 1:9362 EASTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-7870
Mailing Address - Country:US
Mailing Address - Phone:937-607-0201
Mailing Address - Fax:
Practice Address - Street 1:9362 EASTBROOK DR
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-7870
Practice Address - Country:US
Practice Address - Phone:937-607-0201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide