Provider Demographics
NPI:1851701791
Name:NOLTE, KELLY MARIE (CNS)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:NOLTE
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 CEREAL AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-2784
Mailing Address - Country:US
Mailing Address - Phone:513-867-3331
Mailing Address - Fax:513-867-2667
Practice Address - Street 1:1010 CEREAL AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-2784
Practice Address - Country:US
Practice Address - Phone:513-867-3331
Practice Address - Fax:513-867-2667
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.14113-NS364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0102771Medicaid
OH0102771Medicaid
OHH352002Medicare PIN