Healthcare Provider Details

I. General information

NPI: 1770862765
Provider Name (Legal Business Name): KELLY KRISTINE CRANKER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 OLENTANGY RIVER RD SUITE 1080
COLUMBUS OH
43214-3912
US

IV. Provider business mailing address

3555 OLENTANGY RIVER RD SUITE 1080
COLUMBUS OH
43214-3912
US

V. Phone/Fax

Practice location:
  • Phone: 614-268-8164
  • Fax: 614-268-8406
Mailing address:
  • Phone: 614-268-8164
  • Fax: 614-268-8406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number311874
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11034092
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1169175
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.12524
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95031800
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: