Provider Demographics
NPI:1225422025
Name:DOMOSLAWSKI, KAYLEE (APRN)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:DOMOSLAWSKI
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:KAYLEE
Other - Middle Name:
Other - Last Name:TOLLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 CHILDRENS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2639
Mailing Address - Country:US
Mailing Address - Phone:614-722-5175
Mailing Address - Fax:614-355-1395
Practice Address - Street 1:700 CHILDRENS DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2639
Practice Address - Country:US
Practice Address - Phone:617-722-5175
Practice Address - Fax:614-355-1395
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0032651363LP0200X, 363L00000X
OH471928163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care