Provider Demographics
NPI:1780924217
Name:ETTERS, KRYSTAL JO (RN)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:JO
Last Name:ETTERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:JO
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:420 PERINE RD
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-7641
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4690 BUTLER RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43777-9719
Practice Address - Country:US
Practice Address - Phone:740-252-1934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.374253163W00000X
OHAPRN.CNP.0029903363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse