Provider Demographics
NPI:1720675184
Name:ROY, KATHLEEN PHYLLIS
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:PHYLLIS
Last Name:ROY
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 1:3590 US HIGHWAY 23
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-8341
Mailing Address - Country:US
Mailing Address - Phone:740-663-7386
Mailing Address - Fax:
Practice Address - Street 1:3590 US HIGHWAY 23
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-8341
Practice Address - Country:US
Practice Address - Phone:740-663-7386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2683225Medicaid