Healthcare Provider Details

I. General information

NPI: 1427738152
Provider Name (Legal Business Name): KALIE NICOLE FLACK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5031 FOREST DR STE C
NEW ALBANY OH
43054-7088
US

IV. Provider business mailing address

PO BOX 738247
DALLAS TX
75373-8247
US

V. Phone/Fax

Practice location:
  • Phone: 614-647-2526
  • Fax: 877-409-2415
Mailing address:
  • Phone: 614-647-2526
  • Fax: 877-409-2415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.008418RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: