Provider Demographics
NPI:1063560795
Name:SHINADA, KATHLEEN J (NP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:J
Last Name:SHINADA
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:J
Other - Last Name:GOEBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 286
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:OH
Mailing Address - Zip Code:45067-0286
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:730 HILLCREST AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-3305
Practice Address - Country:US
Practice Address - Phone:800-423-6078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH123771163WG0600X
OHNP-01362363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WG0600XNursing Service ProvidersRegistered NurseGerontology