Provider Demographics
NPI:1003004144
Name:MICHAEL, KRISTELL L (APN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTELL
Middle Name:L
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:377 MDG/SGHC 2050A SECOND STREET SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87117-5522
Mailing Address - Country:US
Mailing Address - Phone:505-846-3562
Mailing Address - Fax:334-953-8607
Practice Address - Street 1:US AIR FORCE 377 MDG/SGHC 2050A SECOND STREET SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87117-6027
Practice Address - Country:US
Practice Address - Phone:505-846-3562
Practice Address - Fax:334-953-8607
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX558669363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K6247Medicare PIN