Provider Demographics
NPI:1376111385
Name:SIRE, PARIS KEVONA (CNA)
Entity Type:Individual
Prefix:
First Name:PARIS
Middle Name:KEVONA
Last Name:SIRE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 JAMES GUTHRIE CT APT 4
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-2909
Mailing Address - Country:US
Mailing Address - Phone:502-619-0796
Mailing Address - Fax:
Practice Address - Street 1:2203 JAMES GUTHRIE CT APT 4
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-2909
Practice Address - Country:US
Practice Address - Phone:502-619-0796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1401120075374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty