Healthcare Provider Details

I. General information

NPI: 1073107439
Provider Name (Legal Business Name): KRISTEN NICOLE MARTIN CBD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1836 TAHOE DR
XENIA OH
45385-1148
US

IV. Provider business mailing address

1629 DRAKE DR
XENIA OH
45385-3907
US

V. Phone/Fax

Practice location:
  • Phone: 937-269-9660
  • Fax:
Mailing address:
  • Phone: 937-269-9660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCPM26101093
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: