Healthcare Provider Details

I. General information

NPI: 1104658046
Provider Name (Legal Business Name): PRAMIKA MOKTAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 BURNET AVE
CINCINNATI OH
45229-3014
US

IV. Provider business mailing address

8525 FOXCROFT DR
CINCINNATI OH
45231-5713
US

V. Phone/Fax

Practice location:
  • Phone: 513-357-7200
  • Fax:
Mailing address:
  • Phone: 513-410-4139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0042444
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: