Provider Demographics
NPI:1144411638
Name:IMBUS, KARLA KAY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KARLA
Middle Name:KAY
Last Name:IMBUS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MEDICAL VILLAGE DRIVE
Mailing Address - Street 2:SUITE 258
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017
Mailing Address - Country:US
Mailing Address - Phone:859-341-7246
Mailing Address - Fax:859-341-7867
Practice Address - Street 1:7655 FIVE MILE ROAD
Practice Address - Street 2:SUITE 117
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230
Practice Address - Country:US
Practice Address - Phone:513-624-7525
Practice Address - Fax:513-624-0578
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.001491363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
352199392OtherHEALTHNET
000000611444OtherANTHEM
OH$$$$$$$$$01OtherBUREAU OF WORKER COMP
OHIMPA16022Medicare PIN
000000611444OtherANTHEM