Healthcare Provider Details

I. General information

NPI: 1164173621
Provider Name (Legal Business Name): ABIGAYLE WESTERHEIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABIGAYLE BARKER PA-C

II. Dates (important events)

Enumeration Date: 01/15/2022
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 NEWARK GRANVILLE RD
GRANVILLE OH
43023-9142
US

IV. Provider business mailing address

6480 HARRISON AVE STE 201
CINCINNATI OH
45247-7961
US

V. Phone/Fax

Practice location:
  • Phone: 740-788-9220
  • Fax:
Mailing address:
  • Phone: 513-818-0043
  • Fax: 513-964-9575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.007427RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: