Healthcare Provider Details

I. General information

NPI: 1184895567
Provider Name (Legal Business Name): KRISTINE PLOTTS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 TAMARACK RD
NEWARK OH
43055-2305
US

IV. Provider business mailing address

1865 TAMARACK RD
NEWARK OH
43055-2305
US

V. Phone/Fax

Practice location:
  • Phone: 220-564-4972
  • Fax: 220-564-4991
Mailing address:
  • Phone: 220-564-4972
  • Fax: 220-564-4991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA.09629-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN.CNP.09629
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.09629
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: