Provider Demographics
NPI:1437443942
Name:GOBLE, KATHY ANN (LPN)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:ANN
Last Name:GOBLE
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 1:8247 STATE ROUTE 61 LOT 22
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:44865-9410
Mailing Address - Country:US
Mailing Address - Phone:567-224-1191
Mailing Address - Fax:
Practice Address - Street 1:8247 STATE ROUTE 61 LOT #22
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:OH
Practice Address - Zip Code:44865
Practice Address - Country:US
Practice Address - Phone:567-224-1191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN110298 MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse