MEDICARE: MS. MARY KAY BARTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	COA-02355NP	OH

General Provider Information

NPI Number	:	1881931764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY KAY BARTH

Provider Business Mailing Address
First Line	:	5719 KIPLINGWOOD DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45239-6609
Country	:	US
Telephone Number	:	513-542-0063
Fax Number	:

Provider Business Practice Location Address
First Line	:	5719 KIPLINGWOOD DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45239-6609
Country	:	US
Telephone Number	:	513-542-0063
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2013
Last Update Date	:	01/11/2013

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