Healthcare Provider Details

I. General information

NPI: 1356993208
Provider Name (Legal Business Name): KATELYN R NYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 E MAIN ST
COLUMBUS OH
43205-2140
US

IV. Provider business mailing address

4653 E MAIN ST
WHITEHALL OH
43213-3298
US

V. Phone/Fax

Practice location:
  • Phone: 142-520-7316
  • Fax:
Mailing address:
  • Phone: 614-875-2371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2204357
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2505778
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: