Provider Demographics
NPI:1467734251
Name:STARGELL, KIFFANY
Entity Type:Individual
Prefix:MISS
First Name:KIFFANY
Middle Name:
Last Name:STARGELL
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 1:1948 VICTORIA AVE APT D
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-2755
Mailing Address - Country:US
Mailing Address - Phone:937-267-0581
Mailing Address - Fax:
Practice Address - Street 1:1948 VICTORIA AVE APT D
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-2755
Practice Address - Country:US
Practice Address - Phone:937-267-0581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400145430802376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide