Provider Demographics
NPI:1609097393
Name:KRISTY, KAREN L (APRN, BC)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:L
Last Name:KRISTY
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3085 FAIRMOUNT BLVD
Mailing Address - Street 2:REAR
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-4128
Mailing Address - Country:US
Mailing Address - Phone:216-548-5004
Mailing Address - Fax:
Practice Address - Street 1:23240 CHAGRIN BLVD.
Practice Address - Street 2:SUITE 270
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-765-0500
Practice Address - Fax:216-765-0521
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN172097COA-1364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult