Healthcare Provider Details

I. General information

NPI: 1477641777
Provider Name (Legal Business Name): KATHY G MCCLISH CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 01/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4357 FERGUSON DR STE. 210
CINCINNATI OH
45245-1689
US

IV. Provider business mailing address

4685 FOREST AVE STE C
CINCINNATI OH
45212-3359
US

V. Phone/Fax

Practice location:
  • Phone: 513-732-0100
  • Fax: 513-732-9006
Mailing address:
  • Phone: 513-891-2813
  • Fax: 513-793-1032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNM-06637
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: