Healthcare Provider Details

I. General information

NPI: 1609525971
Provider Name (Legal Business Name): KRISTIAN RAMAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 E REDSTONE AVE
CRESTVIEW FL
32539-5352
US

IV. Provider business mailing address

4695 LOVEGRASS LN
CRESTVIEW FL
32539-8357
US

V. Phone/Fax

Practice location:
  • Phone: 850-698-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME180604
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: