Provider Demographics
NPI:1558046250
Name:BURRELL, KYMMEKA ASHLEY
Entity Type:Individual
Prefix:
First Name:KYMMEKA
Middle Name:ASHLEY
Last Name:BURRELL
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 1:9113 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-2905
Mailing Address - Country:US
Mailing Address - Phone:216-457-4938
Mailing Address - Fax:
Practice Address - Street 1:9113 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-2905
Practice Address - Country:US
Practice Address - Phone:216-457-4938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide