Provider Demographics
NPI:1205142270
Name:KLINGER, AMY J (CNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:KLINGER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:J
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 SHANNON LN
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-9423
Mailing Address - Country:US
Mailing Address - Phone:614-924-7412
Mailing Address - Fax:614-683-5850
Practice Address - Street 1:5239 COLUMBUS RD STE A
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-9624
Practice Address - Country:US
Practice Address - Phone:614-924-7412
Practice Address - Fax:614-683-5850
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA11760-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3124238Medicaid