Provider Demographics
NPI:1982075362
Name:CLEVES, KAITLIN NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:NICOLE
Last Name:CLEVES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:NICOLE
Other - Last Name:KAUFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5300 FAR HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2381
Mailing Address - Country:US
Mailing Address - Phone:937-433-7536
Mailing Address - Fax:937-433-9612
Practice Address - Street 1:7691 5 MILE RD
Practice Address - Street 2:SUITE 312
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4348
Practice Address - Country:US
Practice Address - Phone:513-232-3332
Practice Address - Fax:513-232-9635
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH004150363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant