Provider Demographics
NPI:1497709117
Name:EDISON, KRISTA SWEENEY (CNM)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:SWEENEY
Last Name:EDISON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:ANN
Other - Last Name:SWEENEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:PO BOX 636256 CENTRAL CREDENTIALING
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:513-585-5505
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:234 GOODMAN ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2364
Practice Address - Country:US
Practice Address - Phone:513-584-3999
Practice Address - Fax:513-584-2579
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNM07571 RN298502367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2453812Medicaid
KY78011814Medicaid
KY78011814Medicaid
OH2453812Medicaid
OHSWNM02823Medicare PIN