Healthcare Provider Details

I. General information

NPI: 1275082679
Provider Name (Legal Business Name): KUINMED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6011 CLEVELAND AVE STE B
COLUMBUS OH
43231-2256
US

IV. Provider business mailing address

6011 CLEVELAND AVE STE B
COLUMBUS OH
43231-2256
US

V. Phone/Fax

Practice location:
  • Phone: 614-966-1690
  • Fax:
Mailing address:
  • Phone: 614-966-1690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17118
License Number StateOH

VIII. Authorized Official

Name: MS. VASTY KLUTSE
Title or Position: OWNER
Credential: DNP FNP-C
Phone: 405-887-5691