Provider Demographics
NPI:1891241774
Name:PEDERSEN, KARI E (CNP)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:E
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KARI
Other - Middle Name:E
Other - Last Name:GRAESSLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:530 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-1500
Mailing Address - Country:US
Mailing Address - Phone:567-371-4418
Mailing Address - Fax:
Practice Address - Street 1:437 WOODSIDE LAKE DR
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-5078
Practice Address - Country:US
Practice Address - Phone:513-368-6271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH019802363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0185398Medicaid