Provider Demographics
NPI:1053665463
Name:BARKAN, KELLIE ELIZABETH (LPN)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:ELIZABETH
Last Name:BARKAN
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 1:1132 OAK AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-4067
Mailing Address - Country:US
Mailing Address - Phone:330-265-0336
Mailing Address - Fax:
Practice Address - Street 1:1132 OAK AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4067
Practice Address - Country:US
Practice Address - Phone:330-265-0336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 145372 M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse