Provider Demographics
NPI:1871926956
Name:KLEIN, KATHY J (RN)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:J
Last Name:KLEIN
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 1:112 PARK DR
Mailing Address - Street 2:APT/SUITE
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410
Mailing Address - Country:US
Mailing Address - Phone:937-830-9438
Mailing Address - Fax:
Practice Address - Street 1:112 PARK DR
Practice Address - Street 2:APT/SUITE
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45410-1314
Practice Address - Country:US
Practice Address - Phone:937-554-7762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2018-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 330079163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse