Provider Demographics
NPI:1306143045
Name:WHELLER, KATHYRN MARIE (CNP)
Entity type:Individual
Prefix:
First Name:KATHYRN
Middle Name:MARIE
Last Name:WHELLER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KATHYRN
Other - Middle Name:
Other - Last Name:LAFOREST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:214 W. BOWERY ST
Mailing Address - Street 2:STE 5200
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308
Mailing Address - Country:US
Mailing Address - Phone:330-543-8030
Mailing Address - Fax:330-543-3850
Practice Address - Street 1:1 PERKINS SQ
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1063
Practice Address - Country:US
Practice Address - Phone:330-543-8521
Practice Address - Fax:330-543-3850
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.12056-NP363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner