Provider Demographics
NPI:1801122809
Name:KEMPER, ALBERTA S (PNP-BC)
Entity type:Individual
Prefix:MISS
First Name:ALBERTA
Middle Name:S
Last Name:KEMPER
Suffix:
Gender:F
Credentials:PNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:742 W WILSON ST
Mailing Address - Street 2:BOX 653
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-2066
Mailing Address - Country:US
Mailing Address - Phone:330-277-3355
Mailing Address - Fax:
Practice Address - Street 1:107 JAVIT CT
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2410
Practice Address - Country:US
Practice Address - Phone:330-797-0455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2009007481363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3128645Medicaid