Provider Demographics
NPI:1134107386
Name:TARTT, KIMBERLY LYNNETTE (CNP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LYNNETTE
Last Name:TARTT
Suffix:
Gender:
Credentials:CNP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:LYNNETTE
Other - Last Name:REGER
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:614-293-7677
Mailing Address - Fax:614-293-1456
Practice Address - Street 1:410 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:614-293-7677
Practice Address - Fax:614-293-1456
Is Sole Proprietor?:No
Enumeration Date:2006-01-07
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.279959363LF0000X
OHCOA08367NP363LF0000X
OHAPRN.CNP.08367363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2721344Medicaid
OH2721344Medicaid