MEDICARE: AMELIA KAIDI WHITLATCH NP-C

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	363LF0000X	Family Nurse Practitioner	COA.12753-NP	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	:	1912280827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMELIA KAIDI WHITLATCH NP-C

Provider Business Mailing Address
First Line	:	6611 CLYO RD
Second Line	:	STE E
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-2785
Country	:	US
Telephone Number	:	937-208-8282
Fax Number	:	937-208-8275

Provider Business Practice Location Address
First Line	:	6611 CLYO RD
Second Line	:	STE E
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-2785
Country	:	US
Telephone Number	:	937-208-8282
Fax Number	:	937-208-8275

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

Provider Enumeration Date	:	09/27/2011
Last Update Date	:	01/02/2020

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