Provider Demographics
NPI:1336657592
Name:ROOF, KYRA (LPN)
Entity Type:Individual
Prefix:
First Name:KYRA
Middle Name:
Last Name:ROOF
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KYRA
Other - Middle Name:
Other - Last Name:NIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:410 N PRINCE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3010
Mailing Address - Country:US
Mailing Address - Phone:717-560-7917
Mailing Address - Fax:717-560-6452
Practice Address - Street 1:15 S 9TH ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-5104
Practice Address - Country:US
Practice Address - Phone:717-273-5992
Practice Address - Fax:717-273-5995
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN298202164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse