Provider Demographics
NPI:1588962013
Name:OPSITNICK, KATHLEEN A (CNP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:OPSITNICK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:A
Other - Last Name:KIRKPATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:3999 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6046
Mailing Address - Country:US
Mailing Address - Phone:216-593-1540
Mailing Address - Fax:216-201-5203
Practice Address - Street 1:3999 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-6046
Practice Address - Country:US
Practice Address - Phone:216-593-1540
Practice Address - Fax:216-201-5203
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.351313-COA1363LA2100X
OHAPRN.CNP.12103363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3128681Medicaid
OHNP88021Medicare UPIN
OH3128681Medicaid