Provider Demographics
NPI:1942810338
Name:RESER, KRISTYN NICOLE (NP-C)
Entity Type:Individual
Prefix:
First Name:KRISTYN
Middle Name:NICOLE
Last Name:RESER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 W MERLIN LN
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:OH
Mailing Address - Zip Code:43410-1478
Mailing Address - Country:US
Mailing Address - Phone:419-937-8697
Mailing Address - Fax:
Practice Address - Street 1:2390 ENTERPRISE ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-8507
Practice Address - Country:US
Practice Address - Phone:419-559-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0027268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily