Provider Demographics
NPI:1639510597
Name:OBERMILLER, KATELYN MICHELLE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:MICHELLE
Last Name:OBERMILLER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74004 DRY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43973-9703
Mailing Address - Country:US
Mailing Address - Phone:330-340-6695
Mailing Address - Fax:
Practice Address - Street 1:819 N 1ST ST
Practice Address - Street 2:
Practice Address - City:DENNISON
Practice Address - State:OH
Practice Address - Zip Code:44621-1003
Practice Address - Country:US
Practice Address - Phone:740-922-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA. 14751-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily