Provider Demographics
NPI:1811082589
Name:CRUM, KIM (CFNP)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:CRUM
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 MATTHEW ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-1635
Mailing Address - Country:US
Mailing Address - Phone:740-374-1400
Mailing Address - Fax:
Practice Address - Street 1:400 MATTHEW ST STE 211
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1656
Practice Address - Country:US
Practice Address - Phone:740-236-4871
Practice Address - Fax:740-571-4358
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV44209363LF0000X
OHCOA NP-2187363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7101029000Medicaid
OH2107106Medicaid
OH2107106Medicaid
S79100Medicare UPIN
OHNP02927Medicare ID - Type Unspecified