Provider Demographics
NPI:1588611859
Name:CASLER, KELLY M (FNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:CASLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:M
Other - Last Name:SMALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1401 STEFFEN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-2338
Mailing Address - Country:US
Mailing Address - Phone:513-554-4100
Mailing Address - Fax:513-554-1102
Practice Address - Street 1:1401 STEFFEN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-2338
Practice Address - Country:US
Practice Address - Phone:513-554-4100
Practice Address - Fax:513-554-1102
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001017746363LF0000X
OHAPRN.CNP.021578363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1588611859Medicaid
OH0256297Medicaid
MOQ71224Medicare UPIN