Provider Demographics
NPI:1184151763
Name:KIRTNER, KORTNI TALYOR
Entity type:Individual
Prefix:
First Name:KORTNI
Middle Name:TALYOR
Last Name:KIRTNER
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 1:1090 NADINE DR
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:OH
Mailing Address - Zip Code:43056-9101
Mailing Address - Country:US
Mailing Address - Phone:740-403-9727
Mailing Address - Fax:
Practice Address - Street 1:3032 DEEDS RD
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-9608
Practice Address - Country:US
Practice Address - Phone:740-408-3542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-15
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health