KEVIN M DIRKSEN (NPI# 1053891168) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053891168 |
| Entity Type | Individual |
| Full Name | KEVIN M DIRKSEN |
| Credential | APRN-CNP |
| Practice Address |
801 Pro Dr Ste D2 Celina OH 45822-3307 |
| Mailing Address |
200 Saint Clair Ave Saint Marys OH 45885-2400 |
| Practice Telephone | 4195866480 |
| Practice Fax Number | 4195868574 |
| Mailing Telephone | 4193001129 |
| Mailing Fax Number | 4193949575 |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2020-08-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | APRN.CNP.023488 | OH | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | GROUP MEDICAID - JTDM FAMILY PRACTICE, LLC | 0105065 | 01 |
| OH | 0313733 | 05 | |
| OH | MEDICARE | H674260 | 01 |
| OH | GROUP PTAN - JTDM FAMILY PRACTICE, LLC | 9934723 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 830 W Main St, Coldwater, OH 458281657 | 4196788446 | 4196785996 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063992857 | Kevin J Dirksen | Nurse Practitioner | 3421 W 9th St, Waterloo, IA 50702-5401 | 2018-08-21 |
| Street Address |
801 PRO DR STE D2 |
| City | CELINA |
| State | OH |
| Zip Code | 45822-3307 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467974014 | Emily Marie Metz | Speech-Language Pathologist | 715 E Wayne St, Celina, OH 45822 | 2017-07-14 |
| 1184161069 | Lyndie Brown | Speech-Language Pathologist | 903 East Wayne Street, Celina, OH 45822 | 2017-01-30 |
| 1225582752 | Momentum Counseling and Consultation, LLC | Social Worker | 427 E Market St, Celina, OH 45822 | 2016-08-13 |
| 1821497546 | Mindy Muhlenkamp | Occupational Therapist | 441 East Market Street, Celina, OH 45822 | 2014-08-19 |
| 1609136951 | Aaron D. Kuhn | Marriage & Family Therapist | 316 W. Market St, Celina, OH 45822 | 2012-05-21 |
| 1740436252 | Luis L. Perez | Family Medicine | 801 Pro Dr Ste D1, Celina, OH 45822 | 2008-08-15 |
| 1356538664 | Assisted Living Concepts Inc | Assisted Living Facility | 1506 Meadowview Drive, Celena, OH 45822 | 2007-10-01 |
| 1336369800 | Mercer County Board of Mrdd | Case Management | 4980 Mud Pike, Celina, OH 45822 | 2007-04-26 |
| 1720101371 | Mercer Residential Services Inc. | Supports Brokerage | 420 Sugar St, Celina, OH 45822 | 2007-04-09 |
| 1831236264 | Kristina M Goffena | Massage Therapist | 6673 Coldwater Beach Rd, Celina, OH 45822 | 2007-02-01 |
| Find all providers in zip 45822 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245328947 | Ronnie Raines | Nurse Practitioner | 100 Old Jefferson Street, Celina, TN 38551 | 2006-10-10 |
| 1093202947 | Jacinda Marie Delk | Nurse Practitioner | 115 Guffey St, Celina, TN 38551-4089 | 2018-04-17 |
| 1477734697 | Stephanie Celine Shelton | Nurse Practitioner | 701 N Preston Rd Ste 100, Celina, TX 75009-3748 | 2007-11-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902407497 | Brooke Ashley Sforza | Nurse Practitioner | 7518 Linnville Rd, Newark, OH 43056-9340 | 2020-11-03 |
| 1295335289 | Ipsa Patel | Nurse Practitioner | 3143 Elora Ln, Fairfield Township, OH 45011-0532 | 2020-10-28 |
| 1043810476 | Rylee Fishman | Nurse Practitioner | 5492 Crossbridge Dr, West Chester, OH 45069-1682 | 2020-10-26 |
| 1467051318 | Tylyn Bova | Nurse Practitioner | 26550 Hoop Rd, Freeport, OH 43973-9013 | 2020-10-21 |
| 1558960674 | Alicia Walls-holler | Nurse Practitioner | 5947 S Jay Rd, West Milton, OH 45383-7722 | 2020-10-20 |
| 1184223513 | Ryan Matthew Costlow | Nurse Practitioner | 5605 Madrid Dr, Austintown, OH 44515-4136 | 2020-10-16 |
| 1699373886 | Erin Lea Williams | Nurse Practitioner | 5828 Winshire Dr, Canal Winchester, OH 43110-8791 | 2020-10-11 |
| 1063010338 | Lauren Crook | Nurse Practitioner | 1381 Fox Fire Ct, Lebanon, OH 45036-4032 | 2020-10-09 |
| 1972100287 | Emily Ann Harper | Nurse Practitioner | 6905 Hospital Dr Ste 200a, Dublin, OH 43016-1690 | 2020-10-08 |
| 1780281337 | Lisa Cowles | Nurse Practitioner | 9200 Worthington Rd Ste 300, Westerville, OH 43082-7240 | 2020-10-07 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.