Provider Demographics
NPI:1861373284
Name:BACON, KRISTEN (BSN, RN, EMTP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:BACON
Suffix:
Gender:F
Credentials:BSN, RN, EMTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2942 DAYTON XENIA RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-6306
Mailing Address - Country:US
Mailing Address - Phone:937-458-2549
Mailing Address - Fax:937-429-7688
Practice Address - Street 1:2942 DAYTON XENIA RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-6306
Practice Address - Country:US
Practice Address - Phone:937-458-2549
Practice Address - Fax:937-429-7688
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.502663163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool