Provider Demographics
NPI:1679982573
Name:KOONS, DEBBY
Entity Type:Individual
Prefix:
First Name:DEBBY
Middle Name:
Last Name:KOONS
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 1:2596 BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-1100
Mailing Address - Country:US
Mailing Address - Phone:614-475-0564
Mailing Address - Fax:
Practice Address - Street 1:2596 BRISTOL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-1100
Practice Address - Country:US
Practice Address - Phone:614-475-0564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2266971Medicaid