Healthcare Provider Details

I. General information

NPI: 1558076729
Provider Name (Legal Business Name): KAELA O'BRIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE. ML 2023
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

5642 HAMILTON AVE # MLC6015
CINCINNATI OH
45224-3114
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4371
  • Fax: 513-636-7657
Mailing address:
  • Phone: 513-636-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0033131
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN.462980
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: