Provider Demographics
NPI:1407391600
Name:SWANK, KAYLI (NP-C)
Entity Type:Individual
Prefix:
First Name:KAYLI
Middle Name:
Last Name:SWANK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ORRVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44667-1714
Mailing Address - Country:US
Mailing Address - Phone:419-989-0118
Mailing Address - Fax:
Practice Address - Street 1:5041 VICTOR DR STE C
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-6028
Practice Address - Country:US
Practice Address - Phone:330-723-3338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-23
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020329363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily