Provider Demographics
NPI:1750965539
Name:OWINGS, KRISTINA TERESA MARIE
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:TERESA MARIE
Last Name:OWINGS
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 1:13642 LITTLE COLA RD
Mailing Address - Street 2:
Mailing Address - City:ROCKBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43149-9730
Mailing Address - Country:US
Mailing Address - Phone:740-270-8853
Mailing Address - Fax:
Practice Address - Street 1:13500 LITTLE COLA RD
Practice Address - Street 2:
Practice Address - City:ROCKBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43149-9730
Practice Address - Country:US
Practice Address - Phone:740-332-6982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-08
Last Update Date:2021-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0093957374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0093957Medicaid