Provider Demographics
NPI:1164490942
Name:YORK, KATHIE J (CNP)
Entity Type:Individual
Prefix:
First Name:KATHIE
Middle Name:J
Last Name:YORK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3339 S WOODMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45213-2011
Mailing Address - Country:US
Mailing Address - Phone:513-351-1822
Mailing Address - Fax:513-251-6700
Practice Address - Street 1:4966 GLENWAY AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-3905
Practice Address - Country:US
Practice Address - Phone:513-251-6600
Practice Address - Fax:513-251-6700
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-286492163W00000X
OHNP-06803363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2403723Medicaid
OHNP 06803OtherOHIO NP LICENSE
OH2403723Medicaid