Healthcare Provider Details

I. General information

NPI: 1801891643
Provider Name (Legal Business Name): KRISTIN OAKS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4845 KNIGHTSBRIDGE BLVD STE 220
COLUMBUS OH
43214-2463
US

IV. Provider business mailing address

455 RILEY AVE
WORTHINGTON OH
43085-3038
US

V. Phone/Fax

Practice location:
  • Phone: 614-299-5838
  • Fax: 614-299-5929
Mailing address:
  • Phone: 614-216-7288
  • Fax: 614-785-9335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34-00-7232-0
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: