Healthcare Provider Details

I. General information

NPI: 1821533522
Provider Name (Legal Business Name): KASIE NIKOLE RECTOR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 STATE ROUTE 125
GEORGETOWN OH
45121-9550
US

IV. Provider business mailing address

1701 MERCY HEALTH PL
CINCINNATI OH
45237-6147
US

V. Phone/Fax

Practice location:
  • Phone: 937-378-2526
  • Fax: 937-378-2540
Mailing address:
  • Phone: 888-696-3541
  • Fax: 513-981-6103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF1216111
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: