Healthcare Provider Details

I. General information

NPI: 1134392798
Provider Name (Legal Business Name): PAMELA JANE KRAFT NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2008
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N MAIN ST STE 120
SPRINGBORO OH
45066-2100
US

IV. Provider business mailing address

1 PRESTIGE PL STE 550
MIAMISBURG OH
45342-6115
US

V. Phone/Fax

Practice location:
  • Phone: 937-762-5030
  • Fax: 937-762-5039
Mailing address:
  • Phone: 937-762-1305
  • Fax: 937-522-7513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.09977-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberCOA.09977-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: