Provider Demographics
NPI:1063951952
Name:CREEDON, KEVIN (NP-C)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:CREEDON
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N SUMMIT ST FL 7
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1531
Mailing Address - Country:US
Mailing Address - Phone:419-794-7700
Mailing Address - Fax:419-794-7715
Practice Address - Street 1:5705 MONCLOVA RD STE 201
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1877
Practice Address - Country:US
Practice Address - Phone:419-794-7700
Practice Address - Fax:419-794-7715
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.365677363L00000X
OHAPRN.CNP.020424363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPENDINGMedicaid
OHPENDINGOtherLICENSE-APRN.CNP
OHPENDINGMedicare PIN