Healthcare Provider Details

I. General information

NPI: 1922876853
Provider Name (Legal Business Name): KIRSTEN ELIZABETH MOSES KINNELL CT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 05/13/2024
Certification Date: 01/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 STARRET ST STE 100
LANCASTER OH
43130-3993
US

IV. Provider business mailing address

1280 GUMWOOD DR
COLUMBUS OH
43229-4425
US

V. Phone/Fax

Practice location:
  • Phone: 740-687-0042
  • Fax:
Mailing address:
  • Phone: 614-499-0907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: