Provider Demographics
NPI:1114933967
Name:O'MEARA, KRISTINA H (NP)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:H
Last Name:O'MEARA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N COUNTY ROAD 25A
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1359
Mailing Address - Country:US
Mailing Address - Phone:937-332-0894
Mailing Address - Fax:937-339-7084
Practice Address - Street 1:1300 N COUNTY ROAD 25A
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1359
Practice Address - Country:US
Practice Address - Phone:937-332-0894
Practice Address - Fax:937-339-7084
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0036169363LP2300X
VA0036169174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care