MEDICARE: KARI E. PEDERSEN 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	019802	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

General Provider Information

NPI Number	:	1891241774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARI E. PEDERSEN CNP

Provider Business Mailing Address
First Line	:	530 S MAIN ST
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45804-1500
Country	:	US
Telephone Number	:	567-371-4418
Fax Number	:

Provider Business Practice Location Address
First Line	:	437 WOODSIDE LAKE DR
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-5078
Country	:	US
Telephone Number	:	513-368-6271
Fax Number	:

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

Provider Enumeration Date	:	08/30/2016
Last Update Date	:	09/10/2021

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