Provider Demographics
NPI:1053726224
Name:STAUFFER, KRISTEN M (CNP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:STAUFFER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:M
Other - Last Name:BANFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:3555 OLENTANGY RIVER RD
Mailing Address - Street 2:SUITE 1080
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3912
Mailing Address - Country:US
Mailing Address - Phone:614-268-8164
Mailing Address - Fax:641-268-8406
Practice Address - Street 1:3555 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 1080
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3912
Practice Address - Country:US
Practice Address - Phone:614-268-8164
Practice Address - Fax:641-268-8406
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.16199363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0108082Medicaid
OHH390360Medicare PIN