Healthcare Provider Details

I. General information

NPI: 1659132199
Provider Name (Legal Business Name): KAYTLYN MARIE GEVEDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYTLYN MARIE SNYDER

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 W TECH RD
MIAMISBURG OH
45342-0955
US

IV. Provider business mailing address

PO BOX 933421
CLEVELAND OH
44193-0039
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-5725
  • Fax: 937-350-3050
Mailing address:
  • Phone: 937-641-5072
  • Fax: 937-641-6129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN.427145
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN.CNP.0036646
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: