MEDICARE: AMBER WHITLATCH MSN, APRN, PMHNP-BC

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	163W00000X	Registered Nurse	509079	OH
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.0033062	OH

General Provider Information

NPI Number	:	1891406401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER WHITLATCH MSN, APRN, PMHNP-BC

Provider Business Mailing Address
First Line	:	7905 S STATE ROUTE 48
Second Line	:
City	:	MAINEVILLE
State	:	OH
Zip	:	45039-8933
Country	:	US
Telephone Number	:	213-722-3840
Fax Number	:	513-296-6872

Provider Business Practice Location Address
First Line	:	7905 S STATE ROUTE 48
Second Line	:
City	:	MAINEVILLE
State	:	OH
Zip	:	45039-8933
Country	:	US
Telephone Number	:	213-722-3840
Fax Number	:	513-296-6872

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

Provider Enumeration Date	:	12/06/2022
Last Update Date	:	03/28/2025

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