Healthcare Provider Details

I. General information

NPI: 1326436809
Provider Name (Legal Business Name): MOHAMED S H KUYATEH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9154 PALOMINO DR
PICKERINGTON OH
43147-8228
US

IV. Provider business mailing address

9154 PALOMINO DR
PICKERINGTON OH
43147-8228
US

V. Phone/Fax

Practice location:
  • Phone: 614-717-3695
  • Fax:
Mailing address:
  • Phone: 614-717-3695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.004004
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: