Healthcare Provider Details

I. General information

NPI: 1619499076
Provider Name (Legal Business Name): ANTENNIE D AULD NP-PMH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9388 SHERBORN DR
CINCINNATI OH
45231
US

IV. Provider business mailing address

11134 LUSCHEK DR
BLUE ASH OH
45241-2434
US

V. Phone/Fax

Practice location:
  • Phone: 513-207-7447
  • Fax:
Mailing address:
  • Phone: 513-207-7447
  • Fax: 513-207-7447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.020969
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.020969
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: