Healthcare Provider Details

I. General information

NPI: 1154828127
Provider Name (Legal Business Name): KATHERINE MARY HAGEDORN NELTNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 THOMAS MORE PKWY
CRESTVIEW HILLS KY
41017-3464
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-3383
  • Fax: 859-578-2013
Mailing address:
  • Phone: 859-341-3383
  • Fax: 859-578-2013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberTP639
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number58436
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: