Provider Demographics
NPI:1275536542
Name:TETIRICK, PATRICIA A (NP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:TETIRICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 READING RD
Mailing Address - Street 2:STE.150
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-1454
Mailing Address - Country:US
Mailing Address - Phone:513-721-3200
Mailing Address - Fax:513-639-3186
Practice Address - Street 1:7495 STATE RD
Practice Address - Street 2:STE 300
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-6402
Practice Address - Country:US
Practice Address - Phone:513-231-3447
Practice Address - Fax:513-231-3761
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN137342163W00000X
OHNP1361363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHTENP08902Medicare ID - Type Unspecified
OH2264473Medicare ID - Type Unspecified
OHTENP08901Medicare ID - Type Unspecified
OHP40967Medicare UPIN