Healthcare Provider Details

I. General information

NPI: 1164490942
Provider Name (Legal Business Name): KATHIE J YORK CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4966 GLENWAY AVE SUITE 3
CINCINNATI OH
45238-3905
US

IV. Provider business mailing address

3339 S WOODMONT AVE
CINCINNATI OH
45213-2011
US

V. Phone/Fax

Practice location:
  • Phone: 513-251-6600
  • Fax: 513-251-6700
Mailing address:
  • Phone: 513-351-1822
  • Fax: 513-251-6700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP-06803
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-286492
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: