Healthcare Provider Details

I. General information

NPI: 1811589351
Provider Name (Legal Business Name): HANNAH OTTE KIDWELL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH OTTE PA-C

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 AUBURN AVE STE 428
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

PO BOX 636210
CINCINNATI OH
45263-6210
US

V. Phone/Fax

Practice location:
  • Phone: 513-206-1222
  • Fax: 513-585-2095
Mailing address:
  • Phone: 513-351-9900
  • Fax: 513-366-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.006602RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTC091
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: