Provider Demographics
NPI:1427204908
Name:TRIPLETT, KHALILAH T,
Entity Type:Individual
Prefix:MISS
First Name:KHALILAH
Middle Name:T,
Last Name:TRIPLETT
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 1:1809 CHRISTIAN AVE APT 224
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-2962
Mailing Address - Country:US
Mailing Address - Phone:419-474-4320
Mailing Address - Fax:
Practice Address - Street 1:1809 CHRISTIAN AVE APT 224
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-2962
Practice Address - Country:US
Practice Address - Phone:419-474-4320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 128680164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse