Provider Demographics
NPI:1629561162
Name:SKINNER, KRISTINA ELIZABETH (NP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:ELIZABETH
Last Name:SKINNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:KRISTINA
Other - Middle Name:E
Other - Last Name:SKINNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:128 N CORKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-7894
Mailing Address - Country:US
Mailing Address - Phone:614-813-8491
Mailing Address - Fax:
Practice Address - Street 1:607 HEBRON RD
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:OH
Practice Address - Zip Code:43056-1404
Practice Address - Country:US
Practice Address - Phone:937-450-1244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-10
Last Update Date:2018-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF03180755363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty