Healthcare Provider Details

I. General information

NPI: 1790692689
Provider Name (Legal Business Name): MOLLY KNEBEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 SOUTHERN BLVD STE 300
KETTERING OH
45429-1265
US

IV. Provider business mailing address

3159 BUGLE BLUFF DR
BELLBROOK OH
45305-8854
US

V. Phone/Fax

Practice location:
  • Phone: 937-643-9299
  • Fax: 937-643-2343
Mailing address:
  • Phone: 937-701-2749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.010534RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: