Provider Demographics
NPI:1538565940
Name:KIME, MARK A (CRNA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:KIME
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 MILLBROOK ST
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9663
Mailing Address - Country:US
Mailing Address - Phone:330-720-2201
Mailing Address - Fax:
Practice Address - Street 1:224 W EXCHANGE ST STE 220
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1726
Practice Address - Country:US
Practice Address - Phone:330-344-7040
Practice Address - Fax:330-344-1714
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-12
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CRNA.16768367500000X
OHCOA.16768-NA163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0158796Medicaid