Provider Demographics
NPI:1407219439
Name:FARKASH, KRISTIE MICHELLE (NP-C)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:MICHELLE
Last Name:FARKASH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KRISTIE
Other - Middle Name:MICHELLE
Other - Last Name:CAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1989 MIAMISBURG CENTERVILLE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3858
Mailing Address - Country:US
Mailing Address - Phone:937-401-7575
Mailing Address - Fax:
Practice Address - Street 1:1989 MIAMISBURG CENTERVILLE RD STE 201
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-3858
Practice Address - Country:US
Practice Address - Phone:937-401-7575
Practice Address - Fax:937-522-8350
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18852363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0164466Medicaid
OHH466790Medicare PIN