=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063951952
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN CREEDON NP-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2017
-----------------------------------------------------
Last Update Date | 08/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1601 BRIGHAM DR STE 150
-----------------------------------------------------
City | PERRYSBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43551-7120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-794-7700
-----------------------------------------------------
Fax | 419-794-7715
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1601 BRIGHAM DR STE 150
-----------------------------------------------------
City | PERRYSBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43551-7120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-794-7700
-----------------------------------------------------
Fax | 419-794-7715
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | RN.365677
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.020424
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------