Active NPI
Holly A Kenreich, CNP
- Family Nurse Practitioner
- Columbus, OH
National Provider Identifier
1184934655
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- COA.11710-NP
- Practice address
- 300 W 10TH Ave
Columbus, OH 43210-1280 - Phone
- (614) 293-8619
- Fax
- (614) 293-6420
- NPI assigned
- Oct 18, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN.349162 | OH | |
| Family Nurse Practitioner | 363LF0000X | COA.11710-NP | OH | Primary |
Addresses
Primary practice location
300 W 10TH Ave
Columbus, OH 43210-1280
Mailing address
320 W 10TH Ave
Columbus, OH 43210-1280
Phone (614) 293-8619
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3107113 | Medicaid | OH |
Other names 1
- Holly A Wagner
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN.349162 | OH | MD | Registered Nurse |
| COA.11710-NP | OH | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lima Memorial Joint Operating Company | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Lima Memorial Health System
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1287360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1361750400000",
"number": "1184934655",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "320 W 10TH AVE",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432101280",
"telephone_number": "614-293-8619",
"fax_number": "614-293-6420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 W 10TH AVE",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432101280",
"telephone_number": "614-293-8619",
"fax_number": "614-293-6420"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENREICH",
"first_name": "HOLLY",
"middle_name": "A",
"credential": "CNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-10-18",
"last_updated": "2013-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "OH",
"license": "RN.349162",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "OH",
"license": "COA.11710-NP",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3107113",
"state": "OH"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "HOLLY",
"last_name": "WAGNER",
"middle_name": "A",
"credential": "CNP",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.