Active NPI
Kimyatta E Fair, STNA
- Nurse's Aide
- Cleveland, OH
National Provider Identifier
1205429172
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Dec 20, 2023.
Key facts
NPPES NPI Registry- Primary specialty
- Nurse's Aide
- License
- 0303392
- Practice address
- 3974 E 121St St
Cleveland, OH 44105-4551 - Phone
- (216) 609-6411
- NPI assigned
- Feb 11, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | 0303392 | OH | Primary |
Addresses
Primary practice location
3974 E 121St St
Cleveland, OH 44105-4551
Mailing address
3974 E 121St St
Cleveland, OH 44105-4551
Phone (216) 609-6411
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0303392 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0303392 | OH | MD | Nurse's Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1613001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613001600000",
"number": "1205429172",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3974 E 121ST ST",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441054551",
"telephone_number": "216-609-6411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3974 E 121ST ST",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441054551",
"telephone_number": "216-609-6411"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAIR",
"first_name": "KIMYATTA",
"middle_name": "E",
"credential": "STNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-02-11",
"last_updated": "2021-02-11",
"certification_date": "2021-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "376K00000X",
"taxonomy_group": "",
"desc": "Nurse's Aide",
"state": "OH",
"license": "0303392",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0303392",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cleveland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.