Provider Demographics
NPI:1457662215
Name:WHISMAN, KAYLAE B (APRN)
Entity Type:Individual
Prefix:
First Name:KAYLAE
Middle Name:B
Last Name:WHISMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-341-3383
Mailing Address - Fax:859-578-2013
Practice Address - Street 1:830 THOMAS MORE PKWY
Practice Address - Street 2:SUITE 200 B
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-5102
Practice Address - Country:US
Practice Address - Phone:859-301-8686
Practice Address - Fax:859-301-8690
Is Sole Proprietor?:No
Enumeration Date:2010-06-27
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006112363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100213540Medicaid
KYP01258707OtherRAIL ROAD MEDICARE
OH1457662215Medicaid
KY7100213540Medicaid