Provider Demographics
NPI:1407078520
Name:FREY, KARA MICHELLE (PA-C, ATC-L)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:MICHELLE
Last Name:FREY
Suffix:
Gender:F
Credentials:PA-C, ATC-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 YANKEE RD.
Mailing Address - Street 2:ML 16062
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-3500
Mailing Address - Country:US
Mailing Address - Phone:513-636-3200
Mailing Address - Fax:513-803-1111
Practice Address - Street 1:7777 YANKEE RD
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-3500
Practice Address - Country:US
Practice Address - Phone:513-636-3200
Practice Address - Fax:513-803-1111
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT6092255A2300X
FLPA9107965363A00000X
OH50.005088RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer