Healthcare Provider Details

I. General information

NPI: 1417520065
Provider Name (Legal Business Name): KRYSTAL A BUCKRIDGE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 S MAIN ST STE 440
AKRON OH
44311-4407
US

IV. Provider business mailing address

5430 DOWNINGSGATE CIR NW
CANTON OH
44718-3813
US

V. Phone/Fax

Practice location:
  • Phone: 909-679-3482
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0029346
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0029346
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: