Provider Demographics
NPI:1043389877
Name:BRASHEAR, KRYSTINE KAY (ARNP)
Entity Type:Individual
Prefix:
First Name:KRYSTINE
Middle Name:KAY
Last Name:BRASHEAR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 382ND AVE
Mailing Address - Street 2:
Mailing Address - City:ESTHERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:51334-7506
Mailing Address - Country:US
Mailing Address - Phone:712-362-8925
Mailing Address - Fax:
Practice Address - Street 1:619 2ND AVE N
Practice Address - Street 2:
Practice Address - City:ESTHERVILLE
Practice Address - State:IA
Practice Address - Zip Code:51334-1942
Practice Address - Country:US
Practice Address - Phone:712-362-2404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF-092003363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health