Provider Demographics
NPI:1558637991
Name:KASINEC, KRISTA WILLINGHAM (DO)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:WILLINGHAM
Last Name:KASINEC
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:JOY
Other - Last Name:WILLINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 746071
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6071
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:773-866-8014
Practice Address - Street 1:4271 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-1406
Practice Address - Country:US
Practice Address - Phone:937-971-7031
Practice Address - Fax:937-949-5839
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ4547207Q00000X
OH34.016360207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine