MEDICARE: KATHIE J YORK CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN-286492	OH
2	363L00000X	Nurse Practitioner	NP-06803	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	NP 06803	OTHER	OH	OHIO NP LICENSE

General Provider Information

NPI Number	:	1164490942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHIE J YORK CNP

Provider Business Mailing Address
First Line	:	3339 S WOODMONT AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45213-2011
Country	:	US
Telephone Number	:	513-351-1822
Fax Number	:	513-251-6700

Provider Business Practice Location Address
First Line	:	4966 GLENWAY AVE
Second Line	:	SUITE 3
City	:	CINCINNATI
State	:	OH
Zip	:	45238-3905
Country	:	US
Telephone Number	:	513-251-6600
Fax Number	:	513-251-6700

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	03/05/2012

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