Provider Demographics
NPI:1679657514
Name:STEPHENS, KRISTINE M (RNC,CNP)
Entity type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:M
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:RNC,CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 TAPPAN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-3346
Mailing Address - Country:US
Mailing Address - Phone:614-294-2079
Mailing Address - Fax:
Practice Address - Street 1:310 TAPPAN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-3346
Practice Address - Country:US
Practice Address - Phone:614-294-2070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCA 304363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology