Healthcare Provider Details

I. General information

NPI: 1437747938
Provider Name (Legal Business Name): KATHRYN WHITTEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2021
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 7TH AVE STE 200
CHARDON OH
44024-2909
US

IV. Provider business mailing address

6480 HARRISON AVE STE 201
CINCINNATI OH
45247-7961
US

V. Phone/Fax

Practice location:
  • Phone: 440-285-4999
  • Fax: 440-285-5870
Mailing address:
  • Phone: 513-713-1779
  • Fax: 513-854-9921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.006751RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: