Provider Demographics
NPI:1881147577
Name:KORST, KATHERINE LYNN
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LYNN
Last Name:KORST
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:FRESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5705 S STATE ROUTE 48
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-9798
Mailing Address - Country:US
Mailing Address - Phone:513-677-6062
Mailing Address - Fax:513-677-6063
Practice Address - Street 1:5705 S STATE ROUTE 48
Practice Address - Street 2:
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039-9798
Practice Address - Country:US
Practice Address - Phone:513-677-6062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.019517363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily