Provider Demographics
NPI:1578118691
Name:NYMBERG, KRYSTAL (PA-C)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:NYMBERG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:
Other - Last Name:KAISER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:MLC 2004
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4770
Mailing Address - Fax:513-636-3847
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:MLC 2004
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-4770
Practice Address - Fax:513-636-3847
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006209RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant