Provider Demographics
NPI:1235657420
Name:REILLY, KARA (LSW, LICDC, RN, APRN)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:REILLY
Suffix:
Gender:F
Credentials:LSW, LICDC, RN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4466 RANCHVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-2744
Mailing Address - Country:US
Mailing Address - Phone:419-376-2179
Mailing Address - Fax:
Practice Address - Street 1:4466 RANCHVIEW AVE
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-2744
Practice Address - Country:US
Practice Address - Phone:419-376-2179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.434430163W00000X
OHAPRN.CNP.022864363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse