Provider Demographics
NPI:1003429218
Name:ROPPELT, KRISTA ANN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:ANN
Last Name:ROPPELT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:CLEVENGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:988 E MCNAIR DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-4767
Mailing Address - Country:US
Mailing Address - Phone:480-238-2426
Mailing Address - Fax:
Practice Address - Street 1:3155 E SOUTHERN AVE STE 203
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5521
Practice Address - Country:US
Practice Address - Phone:480-325-8173
Practice Address - Fax:480-325-8179
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ246766363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily