Provider Demographics
NPI:1346842531
Name:BAYES, KATHY SUSAN
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:SUSAN
Last Name:BAYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-4933
Mailing Address - Country:US
Mailing Address - Phone:937-408-7125
Mailing Address - Fax:
Practice Address - Street 1:4110 BENTLEY DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-3702
Practice Address - Country:US
Practice Address - Phone:937-408-7125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2768581Medicaid