Individual
KAYCE C KRUCKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1120 POLARIS PKWY STE 210, COLUMBUS, OH 43240-4057
(614) 434-5431
(614) 961-1072
Mailing address
1120 POLARIS PKWY STE 210, COLUMBUS, OH 43240-4057
(614) 434-5431
(614) 961-1072
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.007009RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0454227
—
OH
Enumeration date
10/24/2017
Last updated
11/15/2022
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