Provider Demographics
NPI:1003151150
Name:WOLFE, KEVIN (APRN)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:WOLFE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2379
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2379
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:2001 SCIOTO TRL
Practice Address - Street 2:STE 200
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2845
Practice Address - Country:US
Practice Address - Phone:740-353-8100
Practice Address - Fax:740-353-8908
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007555363LF0000X
OH13506-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0083552Medicaid
KY7100241090Medicaid
WV3810025857Medicaid
OH0083552Medicaid
KY7100241090Medicaid