Provider Demographics
NPI:1285208363
Name:ACKERMAN, KATHERINE (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:ACKERMAN
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 1:5449 CHRISTY LN
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-2892
Mailing Address - Country:US
Mailing Address - Phone:513-373-2021
Mailing Address - Fax:
Practice Address - Street 1:5449 CHRISTY LN
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-2892
Practice Address - Country:US
Practice Address - Phone:513-373-2021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006769RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant