MEDICARE: KRISTOPHER OLDHAM PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	85572	KS
2	363L00000X	Nurse Practitioner	ARNP9441031	FL
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP128222	TX
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	85572	KS
5	363L00000X	Nurse Practitioner	AP128222	TX
6	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	ARNP9441031	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619357787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTOPHER OLDHAM PMHNP-BC

Provider Business Mailing Address
First Line	:	5510 N HESPERIDES ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-5414
Country	:	US
Telephone Number	:	813-467-6111
Fax Number	:	813-467-6013

Provider Business Practice Location Address
First Line	:	1223 DANIELS RD
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-3835
Country	:	US
Telephone Number	:	689-240-7945
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2015
Last Update Date	:	06/23/2026

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