Provider Demographics
NPI:1366928145
Name:KAMENIK, MORGAN R (CNP)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:R
Last Name:KAMENIK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 EDGEFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-5801
Mailing Address - Country:US
Mailing Address - Phone:740-914-4178
Mailing Address - Fax:740-386-2640
Practice Address - Street 1:1016 SUGARBUSH DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-9489
Practice Address - Country:US
Practice Address - Phone:419-903-0404
Practice Address - Fax:419-903-9405
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH023188363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty