Basic Information
| Provider Information | |||||||||
| NPI: | 1437422243 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARREN | ||||||||
| FirstName: | KARA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | ACNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6680 POE AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454142855 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372808366 | ||||||||
| FaxNumber: | 9372456330 | ||||||||
| Practice Location | |||||||||
| Address1: | 3120 GOVERNORS PLACE BLVD | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454091328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372931622 | ||||||||
| FaxNumber: | 9372456308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2012 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LC0200X | COA.13128-NP | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0092776 | 05 | OH | MEDICAID |