Healthcare Provider Details

I. General information

NPI: 1609097393
Provider Name (Legal Business Name): KAREN L KRISTY APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23240 CHAGRIN BLVD. SUITE 270
BEACHWOOD OH
44122
US

IV. Provider business mailing address

3085 FAIRMOUNT BLVD REAR
CLEVELAND HEIGHTS OH
44118-4128
US

V. Phone/Fax

Practice location:
  • Phone: 216-765-0500
  • Fax: 216-765-0521
Mailing address:
  • Phone: 216-548-5004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN172097COA-1
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: