Provider Demographics
NPI:1174832323
Name:CARPENTER, KRISTA ANN (RN, CNP)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:ANN
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:ANN
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, CNP
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:ORTHOPAEDIC SURGERY ML 2017
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4454
Mailing Address - Fax:513-636-3928
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:ORTHOPAEDIC SURGERY ML 2017
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-4454
Practice Address - Fax:513-636-3928
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.11941-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0105916Medicaid