Healthcare Provider Details

I. General information

NPI: 1821592411
Provider Name (Legal Business Name): KATHRYN MAGOON LINK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 CEREAL AVE STE 207
HAMILTON OH
45013-2772
US

IV. Provider business mailing address

4685 FOREST AVEMUE
CINCINNATI OH
45212-3397
US

V. Phone/Fax

Practice location:
  • Phone: 513-867-3331
  • Fax:
Mailing address:
  • Phone: 513-853-6470
  • Fax: 513-852-8525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.005516RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: