Provider Demographics
NPI:1992180434
Name:WILLIAMS, KRISTEN HASKINS (AGNP-C, MSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:HASKINS
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:AGNP-C, MSN, RN
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:MICHELLE
Other - Last Name:HASKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 570
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1579
Mailing Address - Country:US
Mailing Address - Phone:614-685-5695
Mailing Address - Fax:614-293-4726
Practice Address - Street 1:410 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:614-685-5695
Practice Address - Fax:614-293-4726
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.381828163W00000X
OHAPRN.CNP.17288363LA2200X
OHCOA.17288-NP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0145036Medicaid