Provider Demographics
NPI:1831831791
Name:CHAPPELL, KIANA S
Entity type:Individual
Prefix:
First Name:KIANA
Middle Name:S
Last Name:CHAPPELL
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 1:1635 LAKEFRONT AVE
Mailing Address - Street 2:
Mailing Address - City:EASTCLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112
Mailing Address - Country:US
Mailing Address - Phone:216-860-2578
Mailing Address - Fax:
Practice Address - Street 1:1635 LAKEFRONT AVE
Practice Address - Street 2:
Practice Address - City:EASTCLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112
Practice Address - Country:US
Practice Address - Phone:216-860-2578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTM908743376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH993739Medicaid