Provider Demographics
NPI:1043672645
Name:WISLER, KRISTEN E (CNP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:E
Last Name:WISLER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6488 E MAIN ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-7310
Mailing Address - Country:US
Mailing Address - Phone:614-860-8080
Mailing Address - Fax:614-860-8061
Practice Address - Street 1:6488 E MAIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-7310
Practice Address - Country:US
Practice Address - Phone:614-860-8080
Practice Address - Fax:614-860-8061
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.18801363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0163005Medicaid
OHH296570Medicare PIN