Healthcare Provider Details

I. General information

NPI: 1548794001
Provider Name (Legal Business Name): KRISTINA CULOTTA CAMPBELL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 W CENTRAL AVE
SPRINGBORO OH
45066-1106
US

IV. Provider business mailing address

360 W CENTRAL AVE
SPRINGBORO OH
45066-1106
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-7100
  • Fax: 937-208-7125
Mailing address:
  • Phone: 937-208-7100
  • Fax: 937-208-7125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO.1920
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberS9664
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.016673
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: