Healthcare Provider Details

I. General information

NPI: 1881931764
Provider Name (Legal Business Name): MS. MARY KAY BARTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5719 KIPLINGWOOD DR
CINCINNATI OH
45239-6609
US

IV. Provider business mailing address

5719 KIPLINGWOOD DR
CINCINNATI OH
45239-6609
US

V. Phone/Fax

Practice location:
  • Phone: 513-542-0063
  • Fax:
Mailing address:
  • Phone: 513-542-0063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCOA-02355NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: