Provider Demographics
NPI:1609566728
Name:PATEL, KRYSTALYN K (PNP)
Entity Type:Individual
Prefix:
First Name:KRYSTALYN
Middle Name:K
Last Name:PATEL
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:KRYSTALYN
Other - Middle Name:
Other - Last Name:METRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4488 W 133RD ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-2904
Mailing Address - Country:US
Mailing Address - Phone:330-391-0205
Mailing Address - Fax:
Practice Address - Street 1:9772 DIAGONAL RD
Practice Address - Street 2:
Practice Address - City:MANTUA
Practice Address - State:OH
Practice Address - Zip Code:44255-9128
Practice Address - Country:US
Practice Address - Phone:330-391-0205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0029010363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics