Provider Demographics
NPI:1184191777
Name:CHRISTIAN, KELLY LOUISE
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LOUISE
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LOUISE
Other - Last Name:COCHRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:237 WILLIAM HOWARD TAFT RD
Mailing Address - Street 2:CBO2-3, ATTN - CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2610
Mailing Address - Country:US
Mailing Address - Phone:513-263-8571
Mailing Address - Fax:513-263-8622
Practice Address - Street 1:6939 COX RD
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45069-7595
Practice Address - Country:US
Practice Address - Phone:513-564-1600
Practice Address - Fax:513-564-4001
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNM.019386367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife