Provider Demographics
NPI:1821081571
Name:KAISER, MARY JULIA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JULIA
Last Name:KAISER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:JULIA
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
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:859-301-7210
Mailing Address - Fax:859-301-7216
Practice Address - Street 1:1 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3403
Practice Address - Country:US
Practice Address - Phone:859-301-5650
Practice Address - Fax:859-301-6050
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004387363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000348467OtherANTHEM
KY78012762Medicaid
KY000000348467OtherANTHEM
KY78012762Medicaid