Provider Demographics
NPI:1447964069
Name:ROYALTY, PAIGE
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:ROYALTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7034 TOWN MARKET LN W
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-8277
Mailing Address - Country:US
Mailing Address - Phone:740-238-0871
Mailing Address - Fax:
Practice Address - Street 1:1330 CLARK ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-9614
Practice Address - Country:US
Practice Address - Phone:740-891-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.452237163WX0003X
OHAPRN.CNP.0037591363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, InpatientGroup - Multi-Specialty