=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194692137
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KRYSTAL HERNANDEZ KANE PSYCHOLOGIST LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2025
-----------------------------------------------------
Last Update Date | 10/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 670 MERIDIAN WAY STE 148
-----------------------------------------------------
City | WESTERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43082-2301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-964-4545
-----------------------------------------------------
Fax | 614-964-4546
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 670 MERIDIAN WAY STE 148
-----------------------------------------------------
City | WESTERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43082-2301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-964-4545
-----------------------------------------------------
Fax | 614-964-4546
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST
-----------------------------------------------------
Name | KRYSTAL HERNANDEZ KANE
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 614-964-4545
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------