Healthcare Provider Details

I. General information

NPI: 1770001190
Provider Name (Legal Business Name): MOLLY HELEN FARRELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 AUBURN AVE STE 723
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

2123 AUBURN AVE STE 723
CINCINNATI OH
45219-2906
US

V. Phone/Fax

Practice location:
  • Phone: 513-585-3275
  • Fax: 513-978-5806
Mailing address:
  • Phone: 513-585-3275
  • Fax: 513-978-5806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.005212RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3930
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: