Healthcare Provider Details

I. General information

NPI: 1932408457
Provider Name (Legal Business Name): KRISTEN ELIZABETH O'CONNOR RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 SAWMILL RD
COLUMBUS OH
43220-2490
US

IV. Provider business mailing address

7751 WAGGONER CHASE BLVD
BLACKLICK OH
43004-9191
US

V. Phone/Fax

Practice location:
  • Phone: 614-923-0475
  • Fax:
Mailing address:
  • Phone: 740-334-0069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number6694
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: