Provider Demographics
NPI:1063147445
Name:SOVIAK, KIP WILLIAM (FNP)
Entity type:Individual
Prefix:
First Name:KIP
Middle Name:WILLIAM
Last Name:SOVIAK
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44814-9608
Mailing Address - Country:US
Mailing Address - Phone:419-541-1332
Mailing Address - Fax:
Practice Address - Street 1:1912 HAYES AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-4736
Practice Address - Country:US
Practice Address - Phone:419-541-1332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0031836363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily