Provider Demographics
NPI:1033004015
Name:BYNUM, AMBER KELLY (RN)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:KELLY
Last Name:BYNUM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 FOLKERTH AVE TRLR 59
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-9091
Mailing Address - Country:US
Mailing Address - Phone:937-489-9353
Mailing Address - Fax:
Practice Address - Street 1:632 WAGNER AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-2649
Practice Address - Country:US
Practice Address - Phone:937-365-2275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.53024163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse