Healthcare Provider Details

I. General information

NPI: 1982175865
Provider Name (Legal Business Name): KELCEY E ROHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date: 09/20/2019
Reactivation Date: 07/08/2020

III. Provider practice location address

3645 STONECREEK BLVD UNIT B
CINCINNATI OH
45251-1469
US

IV. Provider business mailing address

3645 STONECREEK BLVD UNIT B
CINCINNATI OH
45251-1469
US

V. Phone/Fax

Practice location:
  • Phone: 513-245-7580
  • Fax:
Mailing address:
  • Phone: 513-245-7580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number359481
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1164641
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3013817
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0026761
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: