Healthcare Provider Details

I. General information

NPI: 1679657514
Provider Name (Legal Business Name): KRISTINE M STEPHENS R.N.C.,C.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 TAPPAN ST
COLUMBUS OH
43201-3346
US

IV. Provider business mailing address

310 TAPPAN ST
COLUMBUS OH
43201-3346
US

V. Phone/Fax

Practice location:
  • Phone: 614-294-2070
  • Fax:
Mailing address:
  • Phone: 614-294-2079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberCA 304
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: