Healthcare Provider Details

I. General information

NPI: 1144411638
Provider Name (Legal Business Name): KARLA KAY IMBUS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7655 FIVE MILE ROAD SUITE 117
CINCINNATI OH
45230
US

IV. Provider business mailing address

20 MEDICAL VILLAGE DRIVE SUITE 258
EDGEWOOD KY
41017
US

V. Phone/Fax

Practice location:
  • Phone: 513-624-7525
  • Fax: 513-624-0578
Mailing address:
  • Phone: 859-341-7246
  • Fax: 859-341-7867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.001491
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: