Healthcare Provider Details

I. General information

NPI: 1477147205
Provider Name (Legal Business Name): VICTORIA LYNN HARTLEY PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA LYNN KERSEVAN RN

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 GRISWOLD RD
ELYRIA OH
44035-2305
US

IV. Provider business mailing address

4600 MONTGOMERY RD STE 400
CINCINNATI OH
45212-2600
US

V. Phone/Fax

Practice location:
  • Phone: 833-510-4357
  • Fax:
Mailing address:
  • Phone: 513-873-1269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0042078
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: