Basic Information
| Provider Information | |||||||||
| NPI: | 1770862765 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRANKER | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | KRISTINE | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3555 OLENTANGY RIVER RD | ||||||||
| Address2: | SUITE 1080 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432143912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142688164 | ||||||||
| FaxNumber: | 6142688406 | ||||||||
| Practice Location | |||||||||
| Address1: | 3555 OLENTANGY RIVER RD | ||||||||
| Address2: | SUITE 1080 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432143912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142688164 | ||||||||
| FaxNumber: | 6142688406 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2011 | ||||||||
| LastUpdateDate: | 08/09/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | APRN.CNP.12524 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 0052696 | 05 | OH | MEDICAID |