Provider Demographics
NPI:1982175865
Name:ROHAN, KELCEY E
Entity Type:Individual
Prefix:
First Name:KELCEY
Middle Name:E
Last Name:ROHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 STONECREEK BLVD UNIT B
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45251-1469
Mailing Address - Country:US
Mailing Address - Phone:513-245-7580
Mailing Address - Fax:
Practice Address - Street 1:3645 STONECREEK BLVD UNIT B
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45251-1469
Practice Address - Country:US
Practice Address - Phone:513-245-7580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2020-07-08
Deactivation Date:2019-09-20
Deactivation Code:
Reactivation Date:2020-07-08
Provider Licenses
StateLicense IDTaxonomies
OH359481163W00000X
KY1164641163W00000X
KY3013817363LF0000X
OH0026761363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse