Provider Demographics
NPI:1881996510
Name:GANSTER, KELLY (CNM ARNP)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:
Last Name:GANSTER
Suffix:
Gender:F
Credentials:CNM ARNP
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:859-212-5125
Mailing Address - Fax:859-212-5099
Practice Address - Street 1:7370 TURFWAY RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4895
Practice Address - Country:US
Practice Address - Phone:859-212-5125
Practice Address - Fax:859-212-5099
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006738367A00000X
KY6738M367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3135735Medicaid
KY7100148620Medicaid
KY7100148620Medicaid