Provider Demographics
NPI:1275817462
Name:COON, KATIE LEIGH (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:LEIGH
Last Name:COON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:LEIGH
Other - Last Name:VORIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1524 RED FOX CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-9257
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1524 RED FOX CT
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-9257
Practice Address - Country:US
Practice Address - Phone:740-403-0437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.139840-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse