Basic Information
| Provider Information | |||||||||
| NPI: | 1710932868 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERRIELL | ||||||||
| FirstName: | KATHY | ||||||||
| MiddleName: | O | ||||||||
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| Credential: | CNP, CNS, MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3170 KETTERING BLVD BLDG B3 | ||||||||
| Address2: | |||||||||
| City: | MORAINE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454391924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9379913188 | ||||||||
| FaxNumber: | 9372239811 | ||||||||
| Practice Location | |||||||||
| Address1: | 98 MOSIER PKWY | ||||||||
| Address2: | |||||||||
| City: | BROOKVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453091750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9378334103 | ||||||||
| FaxNumber: | 9378333147 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | NP06989 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
ID Information
| ID | Type | State | Issuer | Description | 000000912245 | 01 | OH | ANTHEM | OTHER | 2335217 | 05 | OH | MEDICAID |