Basic Information
Provider Information
NPI: 1548579964
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KENT
FirstName: CAROLE
MiddleName: ANN
NamePrefix: MRS.
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 632572
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452632572
CountryCode: US
TelephoneNumber: 7172635562
FaxNumber: 7172631566
Practice Location
Address1: 10500 MONTGOMERY RD
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452424402
CountryCode: US
TelephoneNumber: 5138651111
FaxNumber: 5136720212
Other Information
ProviderEnumerationDate: 10/04/2010
LastUpdateDate: 12/28/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X364795OHN Nursing Service ProvidersRegistered Nurse 
367500000X113838OHY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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