Healthcare Provider Details

I. General information

NPI: 1164774212
Provider Name (Legal Business Name): KAILI AMANDA GEHRING PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2012
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 BELMONT AVE
YOUNGSTOWN OH
44505-1052
US

IV. Provider business mailing address

2061 FOX CHASE
MINERAL RIDGE OH
44440-9036
US

V. Phone/Fax

Practice location:
  • Phone: 330-314-9170
  • Fax: 330-759-7436
Mailing address:
  • Phone: 330-240-0534
  • Fax: 330-759-7436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.003638
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: