Provider Demographics
NPI:1336985506
Name:KILPATRICK, AMBER NICOLE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE
Last Name:KILPATRICK
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:STRUBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8500 STATE ROUTE 664 N
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-8559
Mailing Address - Country:US
Mailing Address - Phone:740-503-0560
Mailing Address - Fax:
Practice Address - Street 1:31500 CHIEFTAIN DR
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-8421
Practice Address - Country:US
Practice Address - Phone:740-270-3286
Practice Address - Fax:740-216-4597
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0036931363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health