Provider Demographics
NPI:1720742281
Name:DEPUGH, KRISTA NICOLE (BSN, RN)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:NICOLE
Last Name:DEPUGH
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-1203
Mailing Address - Country:US
Mailing Address - Phone:740-701-1134
Mailing Address - Fax:
Practice Address - Street 1:591 N COURT ST
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1203
Practice Address - Country:US
Practice Address - Phone:740-701-1134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH328461163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse