Healthcare Provider Details

I. General information

NPI: 1063147445
Provider Name (Legal Business Name): KIP WILLIAM SOVIAK FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 HAYES AVE
FREMONT OH
43420-2632
US

IV. Provider business mailing address

37 SOUTH ST
BERLIN HEIGHTS OH
44814-9608
US

V. Phone/Fax

Practice location:
  • Phone: 419-334-3869
  • Fax:
Mailing address:
  • Phone: 419-541-1332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0031836
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0031836
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: