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General NPI Number Information
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NPI Number | 1790662914
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Entity Type | Organization
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Legal Business Name | MKEAC LLC
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Dates
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Enumeration Date | 08/19/2025
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 7916 CARRAWAY CT
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City | MAINEVILLE
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State | OH
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Zip | 45039-8994
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Country | US
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Telephone | 513-463-5788
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Fax |
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Provider Business Mailing Address
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Address Line | 7916 CARRAWAY CT
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City | MAINEVILLE
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State | OH
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Zip | 45039-8994
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | KAITLIN CLARK
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Credential |
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Telephone | 513-509-9455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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