Provider Demographics
NPI:1710932868
Name:FERRIELL, KATHY O (CNP, CNS, MS)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:O
Last Name:FERRIELL
Suffix:
Gender:F
Credentials:CNP, CNS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170 KETTERING BLVD BLDG B3
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1924
Mailing Address - Country:US
Mailing Address - Phone:937-991-3188
Mailing Address - Fax:937-223-9811
Practice Address - Street 1:98 MOSIER PKWY
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:OH
Practice Address - Zip Code:45309-1750
Practice Address - Country:US
Practice Address - Phone:937-833-4103
Practice Address - Fax:937-833-3147
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP06989363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000912245OtherANTHEM
OH2335217Medicaid
OHNS01725Medicare PIN
OH2335217Medicaid
P06589Medicare UPIN