Provider Demographics
NPI:1477641777
Name:MCCLISH, KATHY G (CNM)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:G
Last Name:MCCLISH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4685 FOREST AVE
Mailing Address - Street 2:STE C
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3359
Mailing Address - Country:US
Mailing Address - Phone:513-891-2813
Mailing Address - Fax:513-793-1032
Practice Address - Street 1:4357 FERGUSON DR
Practice Address - Street 2:STE. 210
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1689
Practice Address - Country:US
Practice Address - Phone:513-732-0100
Practice Address - Fax:513-732-9006
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHNM-06637367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2290739Medicaid
OH42001730OtherRAILROAD MEDICARE
OHP46778Medicare UPIN
OH42001730OtherRAILROAD MEDICARE