1174832323 NPI number — KRISTA ANN CARPENTER RN, CNP

Table of content: KRISTA ANN CARPENTER RN, CNP (NPI 1174832323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174832323 NPI number — KRISTA ANN CARPENTER RN, CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARPENTER
Provider First Name:
KRISTA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOLFE
Provider Other First Name:
KRISTA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, CNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1174832323
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3333 BURNET AVE
Provider Second Line Business Mailing Address:
ORTHOPAEDIC SURGERY ML 2017
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45229-3026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-636-4454
Provider Business Mailing Address Fax Number:
513-636-3928

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3333 BURNET AVE
Provider Second Line Business Practice Location Address:
ORTHOPAEDIC SURGERY ML 2017
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45229-3026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-636-4454
Provider Business Practice Location Address Fax Number:
513-636-3928
Provider Enumeration Date:
10/05/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  COA.11941-NP , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0105916 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".