Provider Demographics
NPI:1134348097
Name:KAEHR, KRISTIN M
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:KAEHR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 N FOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-1422
Mailing Address - Country:US
Mailing Address - Phone:937-399-9500
Mailing Address - Fax:
Practice Address - Street 1:5109 W BROAD ST STE 104
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1648
Practice Address - Country:US
Practice Address - Phone:614-279-7690
Practice Address - Fax:614-853-0438
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN328458163W00000X
OH328458163WP0808X
OHPN105287IV164W00000X
OHRN1328458163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse