Healthcare Provider Details

I. General information

NPI: 1255173126
Provider Name (Legal Business Name): KRYSTA MICHELLE JUNKINS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 W CENTRAL AVE STE D
TOLEDO OH
43606-3859
US

IV. Provider business mailing address

4941 LYNBRIDGE LN
TOLEDO OH
43614-2040
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-2192
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number409681
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN.CNM.0019627
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: