Provider Demographics
NPI:1861696668
Name:KYLES, TONJIA N (RN)
Entity type:Individual
Prefix:
First Name:TONJIA
Middle Name:N
Last Name:KYLES
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 1:13119 SOUTHVIEW AVE
Mailing Address - Street 2:UPSTAIRS
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-4639
Mailing Address - Country:US
Mailing Address - Phone:216-751-3421
Mailing Address - Fax:
Practice Address - Street 1:13119 SOUTHVIEW AVE
Practice Address - Street 2:UPSTAIRS
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-4639
Practice Address - Country:US
Practice Address - Phone:216-751-3421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH286855163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2408139Medicaid