Provider Demographics
NPI:1699135392
Name:HERNANDEZ-KANE, KRYSTAL MARIE (PHD)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:MARIE
Last Name:HERNANDEZ-KANE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6264 S SUNBURY RD STE 400
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-2972
Mailing Address - Country:US
Mailing Address - Phone:614-964-4545
Mailing Address - Fax:614-964-4546
Practice Address - Street 1:6264 S SUNBURY RD STE 400
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2972
Practice Address - Country:US
Practice Address - Phone:614-964-4545
Practice Address - Fax:614-964-4546
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-24
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7151103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical