Provider Demographics
NPI:1306031836
Name:KEMPTON, BONNIE L (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:L
Last Name:KEMPTON
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 1:154 WATSON ST
Mailing Address - Street 2:PO BOX 193
Mailing Address - City:DILLONVALE
Mailing Address - State:OH
Mailing Address - Zip Code:43917
Mailing Address - Country:US
Mailing Address - Phone:740-769-7808
Mailing Address - Fax:
Practice Address - Street 1:154 WATSON ST
Practice Address - Street 2:# 193
Practice Address - City:DILLONVALE
Practice Address - State:OH
Practice Address - Zip Code:43917
Practice Address - Country:US
Practice Address - Phone:740-769-7808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN068674164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2313393Medicaid