Healthcare Provider Details

I. General information

NPI: 1760134837
Provider Name (Legal Business Name): KAITLIN ROSEMARY TIPTON PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE, ML 6015
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

4128 MCLEAN DR
CINCINNATI OH
45255-3325
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-0800
  • Fax: 513-803-0823
Mailing address:
  • Phone: 513-288-3837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0030057
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: