Healthcare Provider Details

I. General information

NPI: 1851120984
Provider Name (Legal Business Name): KAITLIN LONDOT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 WEST MAIN ST STE 203
NEWARK OH
43055
US

IV. Provider business mailing address

1717 WEST MAIN ST STE 203
NEWARK OH
43055
US

V. Phone/Fax

Practice location:
  • Phone: 220-564-2950
  • Fax: 220-564-2951
Mailing address:
  • Phone: 220-564-2950
  • Fax: 220-564-2951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0037090
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0037090
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN.417533
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: