Provider Demographics
NPI:1114333531
Name:CALDWELL, KRISTEN (DO)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6147 STATE ROUTE 122 STE 110
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-5201
Mailing Address - Country:US
Mailing Address - Phone:513-261-3500
Mailing Address - Fax:513-261-3509
Practice Address - Street 1:6147 STATE ROUTE 122 STE 110
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45005-5201
Practice Address - Country:US
Practice Address - Phone:513-261-3500
Practice Address - Fax:513-261-3509
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
OH34.013491207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0307646Medicaid