Provider Demographics
NPI:1740012616
Name:MCCONICO, KYMBRIA DIONNE
Entity type:Individual
Prefix:
First Name:KYMBRIA
Middle Name:DIONNE
Last Name:MCCONICO
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 1:750 S MCCORD RD APT 128
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-9426
Mailing Address - Country:US
Mailing Address - Phone:567-900-8266
Mailing Address - Fax:
Practice Address - Street 1:750 S MCCORD RD APT 128
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-9426
Practice Address - Country:US
Practice Address - Phone:567-900-8266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services