Provider Demographics
NPI:1841857182
Name:MEYERS, KATHY JO (RN)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:JO
Last Name:MEYERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:JO
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:11778 CRAIG DR
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44149-3047
Mailing Address - Country:US
Mailing Address - Phone:734-755-2480
Mailing Address - Fax:
Practice Address - Street 1:10701 EAST BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1702
Practice Address - Country:US
Practice Address - Phone:734-755-2480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401468163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse