Healthcare Provider Details

I. General information

NPI: 1467284380
Provider Name (Legal Business Name): KATHERINE MANLEY PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 UNIVERSITY BLVD
HAMILTON OH
45011-3315
US

IV. Provider business mailing address

1020 SYMMES RD
FAIRFIELD OH
45014-1844
US

V. Phone/Fax

Practice location:
  • Phone: 513-896-3497
  • Fax: 513-785-4495
Mailing address:
  • Phone: 513-896-8300
  • Fax: 513-883-1546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN.478878
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0038939
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: