Provider Demographics
NPI:1336403161
Name:YAKURA, KRISTIE A (MSN, PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:KRISTIE
Middle Name:A
Last Name:YAKURA
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:KRIS
Other - Middle Name:
Other - Last Name:YAKURA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:8044 MONTGOMERY RD STE 700
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2926
Mailing Address - Country:US
Mailing Address - Phone:513-277-9614
Mailing Address - Fax:513-436-1822
Practice Address - Street 1:8044 MONTGOMERY RD STE 700
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2926
Practice Address - Country:US
Practice Address - Phone:513-277-9614
Practice Address - Fax:513-436-1822
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.13862-NP363LF0000X
KY3008417363LF0000X
OHRN.263720363LF0000X
OHRN263720363LP0808X
KY1137920163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP10001066725OtherBUCKEYE
OHH270571OtherMEDICARE
OH897718OtherANTHEM
OH4141976OtherAETNA
OH897718OtherANTHEM