Basic Information
Provider Information
NPI: 1306374889
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SLATZER
FirstName: KERI
MiddleName: JO
NamePrefix:  
NameSuffix:  
Credential: CNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 700 ACKERMAN RD STE 570
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432021579
CountryCode: US
TelephoneNumber: 6142934925
FaxNumber:  
Practice Location
Address1: 410 W 10TH AVE
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432101240
CountryCode: US
TelephoneNumber: 6142934925
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/30/2017
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2100XNP123456OHN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
363L00000XAPRNCNP021434OHY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


Home