Healthcare Provider Details

I. General information

NPI: 1205727161
Provider Name (Legal Business Name): KRISTIN RENEE MCGRADY PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. KRISTIN RENEE CLEMENS

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N WATER ST
KENT OH
44240-2418
US

IV. Provider business mailing address

541 SYDNEY PL
TALLMADGE OH
44278-1553
US

V. Phone/Fax

Practice location:
  • Phone: 330-714-5494
  • Fax:
Mailing address:
  • Phone: 330-714-5494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0040216
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: