Kineta Delisse Blackmon

NPI #1598408361 in Fairlawn, Ohio

Provider Information

NPI Number: 1598408361
Entity Type: Individual
Name: Kineta Delisse Blackmon
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Homemaker
Enumeration Date: Apr 19, 2022
Last Updated: Apr 19, 2022

Practice Location

Address: 3800 ROSEMONT BLVD APT 113A
City: Fairlawn
State: Ohio
ZIP Code: 44333-9249
Phone: (330) 245-9849

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Homemaker	376J00000X	Primary

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