Provider Demographics
NPI:1073209490
Name:FELTON, KRISTA (LPN)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:FELTON
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13175 CLAYLICK RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43056-9002
Mailing Address - Country:US
Mailing Address - Phone:740-877-7701
Mailing Address - Fax:
Practice Address - Street 1:13175 CLAYLICK RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43056-9002
Practice Address - Country:US
Practice Address - Phone:740-877-7701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH140203164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse