Individual provider Active NPI

Kristen Gans, MSN, APRN, FNP-C

  • Family Nurse Practitioner
  • Dayton, OH
National Provider Identifier
1619514254
Registry record updated Feb 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
025694 Issued in OH
Practice address
30 E Apple St Ste 1480
Dayton, OH 45409-2939
Phone
(937) 208-7240
Fax
(937) 208-7242
NPI assigned
Dec 3, 2019
Last updated
Feb 18, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 025694 OH Primary

Addresses

Primary practice location

30 E Apple St Ste 1480
Dayton, OH 45409-2939

Mailing address

3170 Kettering Blvd BLDG B3
Moraine, OH 45439-1924
Phone (937) 991-3188

Other identifiers 1

IdentifierTypeStateIssuer
0382559MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
RESTful URL kkolat1665991@direct.premierhealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
025694OHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Health Specialists Inc CurrentSince Jan 20, 2020 Accepting new patients
Premier Health Specialists Inc CurrentSince Jan 20, 2020 Accepting new patients
Premier Heart Associates, Inc Past Accepting new patients

Locations

1 Wyoming St
Fl 3
Dayton, OH 45409
Phone (937) 208-2627

30 E Apple St
#1480
Dayton, OH 45409
Phone (937) 208-3220

30 E Apple St
#6258
Dayton, OH 45409
Phone (937) 208-5300

30 E Apple St
Ste 1480
Dayton, OH 45409
Phone (937) 208-3220

3170 Kettering Blvd
Bldg B
Moraine, OH 45439
Phone (937) 991-3187

3170 Kettering Blvd
Bldg B3
Moraine, OH 45439
Phone (937) 991-3188

450 N Hyatt St
Ste 304
Tipp City, OH 45371
Phone (937) 832-4773

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1575331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613606400000",
    "number": "1619514254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3170 KETTERING BLVD BLDG B3",
            "city": "MORAINE",
            "state": "OH",
            "postal_code": "454391924",
            "telephone_number": "937-991-3188",
            "fax_number": "937-223-9811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 E APPLE ST STE 1480",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454092939",
            "telephone_number": "937-208-7240",
            "fax_number": "937-208-7242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANS",
        "first_name": "KRISTEN",
        "credential": "MSN, APRN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-03",
        "last_updated": "2021-02-18",
        "certification_date": "2021-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "025694",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0382559",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "REST",
            "endpointTypeDescription": "RESTful URL",
            "endpoint": "kkolat1665991@direct.premierhealth.com",
            "affiliation": "N",
            "address_1": "30 E Apple St Ste 1480",
            "city": "Dayton",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454092939",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.