Provider Demographics
NPI:1710356290
Name:KING, CHRISTINA R (CNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:R
Last Name:KING
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CAREN AVENUE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2552
Mailing Address - Country:US
Mailing Address - Phone:614-846-1527
Mailing Address - Fax:614-846-1704
Practice Address - Street 1:55 CAREN AVENUE
Practice Address - Street 2:SUITE 170
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2552
Practice Address - Country:US
Practice Address - Phone:614-846-1527
Practice Address - Fax:614-846-1704
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.17415363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0143963Medicaid
OH0143963Medicaid