Healthcare Provider Details

I. General information

NPI: 1144228263
Provider Name (Legal Business Name): KARLA ANN MORMAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 THE BLVD
MAUMEE OH
43537-7573
US

IV. Provider business mailing address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

V. Phone/Fax

Practice location:
  • Phone: 419-389-1444
  • Fax: 419-407-3515
Mailing address:
  • Phone: 614-722-2000
  • Fax: 419-479-6962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50001914
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: