Healthcare Provider Details

I. General information

NPI: 1962888537
Provider Name (Legal Business Name): LAUREN N KUYKENDALL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 MONTGOMERY RD STE 6345
MONTGOMERY OH
45242-4402
US

IV. Provider business mailing address

10500 MONTGOMERY RD STE 6345
MONTGOMERY OH
45242-4402
US

V. Phone/Fax

Practice location:
  • Phone: 513-865-5167
  • Fax: 513-865-5175
Mailing address:
  • Phone: 513-865-5167
  • Fax: 513-865-5175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.313415
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.17789
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.17789
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: