Provider Demographics
NPI:1053091173
Name:FOX, KATHALEEN (APRN)
Entity type:Individual
Prefix:
First Name:KATHALEEN
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 MEIGS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44045-8204
Mailing Address - Country:US
Mailing Address - Phone:440-488-5137
Mailing Address - Fax:
Practice Address - Street 1:6681 RIDGE RD STE 206
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5705
Practice Address - Country:US
Practice Address - Phone:440-845-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0034457363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care