Basic Information
| Provider Information | |||||||||
| NPI: | 1851701791 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NOLTE | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | CNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 CEREAL AVE | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | HAMILTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450132784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138673331 | ||||||||
| FaxNumber: | 5138672667 | ||||||||
| Practice Location | |||||||||
| Address1: | 1010 CEREAL AVE | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | HAMILTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450132784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138673331 | ||||||||
| FaxNumber: | 5138672667 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2014 | ||||||||
| LastUpdateDate: | 01/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SA2200X | COA.14113-NS | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 0102771 | 05 | OH | MEDICAID |