Healthcare Provider Details

I. General information

NPI: 1851833388
Provider Name (Legal Business Name): CARRIE COGLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 E STROOP RD
KETTERING OH
45429-3245
US

IV. Provider business mailing address

529 E STROOP RD
DAYTON OH
45429-3245
US

V. Phone/Fax

Practice location:
  • Phone: 937-345-4006
  • Fax: 937-345-4093
Mailing address:
  • Phone: 937-345-4006
  • Fax: 937-345-4093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN.CNP.020200
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: