Provider Demographics
NPI:1154552545
Name:KLUTTS, VICKIE L (ARNP)
Entity type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:L
Last Name:KLUTTS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 E TURKEYFOOT LAKE RD
Mailing Address - Street 2:STE. 301
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-5277
Mailing Address - Country:US
Mailing Address - Phone:330-344-8565
Mailing Address - Fax:330-896-7085
Practice Address - Street 1:1622 E TURKEYFOOT LAKE RD
Practice Address - Street 2:STE. 301
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-5277
Practice Address - Country:US
Practice Address - Phone:330-344-8565
Practice Address - Fax:330-896-7085
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.12574363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OH0079091Medicaid
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
OHH165971Medicare PIN