Healthcare Provider Details

I. General information

NPI: 1396624169
Provider Name (Legal Business Name): MEGHAN ELIZABETH KIRSTEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGHAN ELIZABETH KIRSTEN RN

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 W HIGH ST
BRYAN OH
43506-1681
US

IV. Provider business mailing address

114 EMERSON ST
WALDRON MI
49288-9700
US

V. Phone/Fax

Practice location:
  • Phone: 419-636-4517
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704337978
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA.P.R.N.CNP.0039980
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: