Healthcare Provider Details

I. General information

NPI: 1588030050
Provider Name (Legal Business Name): KEVIN J SHOTSBERGER CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 REED RD STE 205
COLUMBUS OH
43220-2553
US

IV. Provider business mailing address

5151 REED RD STE 205
COLUMBUS OH
43220-2553
US

V. Phone/Fax

Practice location:
  • Phone: 614-865-3125
  • Fax:
Mailing address:
  • Phone: 614-865-3125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.18018
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: