Healthcare Provider Details

I. General information

NPI: 1104094291
Provider Name (Legal Business Name): KRISTIN O'DONNELL D.N.P, C.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 CENTRE ST
ASHLAND PA
17921-1330
US

IV. Provider business mailing address

530 CENTRE ST
ASHLAND PA
17921-1330
US

V. Phone/Fax

Practice location:
  • Phone: 570-645-1670
  • Fax:
Mailing address:
  • Phone: 570-645-1670
  • Fax: 570-645-1673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP009671
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: