Provider Demographics
NPI:1508570565
Name:PURDOM, KAYLEIGH N
Entity Type:Individual
Prefix:MRS
First Name:KAYLEIGH
Middle Name:N
Last Name:PURDOM
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 1:2252 CAROLINA DR
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-4612
Mailing Address - Country:US
Mailing Address - Phone:937-768-3058
Mailing Address - Fax:
Practice Address - Street 1:2252 CAROLINA DR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-4612
Practice Address - Country:US
Practice Address - Phone:937-768-3058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide