Healthcare Provider Details

I. General information

NPI: 1801995121
Provider Name (Legal Business Name): KATHLEEN FLESCH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 BURDSALL AVE
FT MITCHELL KY
41017-2824
US

IV. Provider business mailing address

PO BOX 17925
COVINGTON KY
41017-0925
US

V. Phone/Fax

Practice location:
  • Phone: 859-331-4427
  • Fax: 859-331-1735
Mailing address:
  • Phone: 859-331-4427
  • Fax: 859-331-1735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number1036503
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number137492
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: