=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205142270
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY J KLINGER CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2010
-----------------------------------------------------
Last Update Date | 02/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5239 COLUMBUS RD STE A
-----------------------------------------------------
City | GRANVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43023-9624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-924-7412
-----------------------------------------------------
Fax | 614-683-5850
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 SHANNON LN
-----------------------------------------------------
City | GRANVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43023-9423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-924-7412
-----------------------------------------------------
Fax | 614-683-5850
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | COA11760-NP
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------