Provider Demographics
NPI:1861041857
Name:ZIMMERLY, KATIE LEE (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LEE
Last Name:ZIMMERLY
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:LEE
Other - Last Name:GALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-7642
Mailing Address - Fax:614-293-3078
Practice Address - Street 1:460 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:614-293-7642
Practice Address - Fax:614-293-3078
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.365172163W00000X
OHAPRN.CNP.025633363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0371859Medicaid