Provider Demographics
NPI:1811173685
Name:O'BRIEN, KATHLEEN (APRN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-442-6600
Mailing Address - Fax:859-442-6601
Practice Address - Street 1:2093 MEDICAL ARTS DR
Practice Address - Street 2:1ST FLOOR
Practice Address - City:HEBRON
Practice Address - State:KY
Practice Address - Zip Code:41048-9315
Practice Address - Country:US
Practice Address - Phone:859-442-6600
Practice Address - Fax:859-442-6601
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004960363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100141620Medicaid
KYP400029617Medicare PIN
KYK173610Medicare PIN