Provider Demographics
NPI:1508292509
Name:RAHMON, KELLY DANNETTE (LPN)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:DANNETTE
Last Name:RAHMON
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 1:13660 FAIRHILL RD APT 201
Mailing Address - Street 2:
Mailing Address - City:SHAKER HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1261
Mailing Address - Country:US
Mailing Address - Phone:216-334-5300
Mailing Address - Fax:
Practice Address - Street 1:13660 FAIRHILL RD APT 201
Practice Address - Street 2:
Practice Address - City:SHAKER HTS
Practice Address - State:OH
Practice Address - Zip Code:44120-1261
Practice Address - Country:US
Practice Address - Phone:216-334-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101535164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse