Ken Ibeto

Primary specialty

Home Health Clinical Nurse SpecialistTaxonomy code 364SH0200X

License

048-R-2014 Issued in GA

Practice address

7646 Forest Glen Way
Lithia Springs, GA 30122-6867

Phone

(678) 637-6249

Fax

(404) 393-4950

NPI assigned

Jul 10, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kenechukwu Ikechukwu Ibeto Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Omni Healthcare Services LLC

  • In Home Supportive Care Agency
  • Lithia Springs, GA
  • NPI 1477107365
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1531180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531180800000",
    "number": "1053807347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7646 FOREST GLEN WAY",
            "city": "LITHIA SPRINGS",
            "state": "GA",
            "postal_code": "301226867",
            "telephone_number": "678-637-6249",
            "fax_number": "404-393-4950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7646 FOREST GLEN WAY",
            "city": "LITHIA SPRINGS",
            "state": "GA",
            "postal_code": "301226867",
            "telephone_number": "678-637-6249",
            "fax_number": "404-393-4950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBETO",
        "first_name": "KEN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-10",
        "last_updated": "2018-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SH0200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Home Health",
            "state": "GA",
            "license": "048-R-2014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENECHUKWU",
            "last_name": "IBETO",
            "middle_name": "IKECHUKWU",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Angeline Wynne Hixson, O.D.
• Alexandria Hodges, LPC
• Domeka Hubert Tucker, CNA
• Hugging Arms Inc
• Mohammed Nazmul Huq, D.D.S
• Matthew Igbinigie, MD
• Independent Physical Therapy of Ga LLC
• Independent Physical Therapy of Ga, LLC
• Indigo Healing Minds LLC
• Innovative Therapy Group

• Clinical Nurse Specialist in Lithia Springs, GA
• Providers in Lithia Springs, GA by specialty
• Clinical Nurse Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.