Healthcare Provider Details

I. General information

NPI: 1649571613
Provider Name (Legal Business Name): KATHLEEN ANN KRUPA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 HOMESTEAD AVE
WHEELING WV
26003-6638
US

IV. Provider business mailing address

10686 STATE ROUTE 150
RAYLAND OH
43943-7847
US

V. Phone/Fax

Practice location:
  • Phone: 872-231-3162
  • Fax:
Mailing address:
  • Phone: 740-859-5650
  • Fax: 740-859-5685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0035349
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number73991
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0035349
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number73991
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: