Provider Demographics
NPI:1174833867
Name:KNISLEY, PAMELA SUE (CNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:KNISLEY
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:PO BOX 637735
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-7735
Mailing Address - Country:US
Mailing Address - Phone:513-891-1006
Mailing Address - Fax:513-793-1032
Practice Address - Street 1:1402 N HIGH ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-8514
Practice Address - Country:US
Practice Address - Phone:937-393-4899
Practice Address - Fax:937-393-4996
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.11618-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3106794Medicaid