Healthcare Provider Details

I. General information

NPI: 1881588192
Provider Name (Legal Business Name): HOLLY ANN KISTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 COLUMBUS RD NE
LOUISVILLE OH
44641-9230
US

IV. Provider business mailing address

5250 COLUMBUS RD NE
LOUISVILLE OH
44641-9230
US

V. Phone/Fax

Practice location:
  • Phone: 330-327-0359
  • Fax:
Mailing address:
  • Phone: 330-327-0359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: