Healthcare Provider Details

I. General information

NPI: 1700334786
Provider Name (Legal Business Name): KATHERINE LORINE REDICK CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE REDICK CNP

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 01/25/2022
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 E TOWN ST
COLUMBUS OH
43215-4602
US

IV. Provider business mailing address

5450 FRANTZ RD STE 360
DUBLIN OH
43016-4141
US

V. Phone/Fax

Practice location:
  • Phone: 614-788-5400
  • Fax: 614-788-5500
Mailing address:
  • Phone: 614-533-6497
  • Fax: 614-544-6370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.019529
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: