Provider Demographics
NPI:1114935467
Name:SHEETS, KEVANN KIMBERLY (LPN)
Entity Type:Individual
Prefix:MS
First Name:KEVANN
Middle Name:KIMBERLY
Last Name:SHEETS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:KEVANN
Other - Middle Name:KIMBERLY
Other - Last Name:RAYBURN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:3999 STATE ROUTE 521
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-8761
Mailing Address - Country:US
Mailing Address - Phone:740-815-8980
Mailing Address - Fax:
Practice Address - Street 1:3999 STATE ROUTE 521
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-8761
Practice Address - Country:US
Practice Address - Phone:740-815-8980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN096547164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2372954Medicaid