Healthcare Provider Details

I. General information

NPI: 1659287894
Provider Name (Legal Business Name): KAITLYN ANN WADE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

3737 SOUTHERN BLVD
KETTERING OH
45429-1262
US

IV. Provider business mailing address

24756 WEISBURG RD
SUNMAN IN
47041-9443
US

V. Phone/Fax

Practice location:
  • Phone: 937-395-8601
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: