Provider Demographics
NPI:1144228263
Name:MORMAN, KARLA ANN (PA)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:ANN
Last Name:MORMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CHILDRENS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2664
Mailing Address - Country:US
Mailing Address - Phone:614-722-2000
Mailing Address - Fax:419-479-6962
Practice Address - Street 1:500 THE BLVD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-7573
Practice Address - Country:US
Practice Address - Phone:419-389-1444
Practice Address - Fax:419-407-3515
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50001914363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0107684Medicaid
OH95457Medicare UPIN