Provider Demographics
NPI:1073131538
Name:ELGARICO, KRYS LOUELLA (DNP, NP-C)
Entity Type:Individual
Prefix:
First Name:KRYS
Middle Name:LOUELLA
Last Name:ELGARICO
Suffix:
Gender:F
Credentials:DNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E HARDING WAY STE D
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6118
Mailing Address - Country:US
Mailing Address - Phone:209-944-5750
Mailing Address - Fax:
Practice Address - Street 1:415 E HARDING WAY STE D
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6118
Practice Address - Country:US
Practice Address - Phone:209-944-5750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022394363L00000X
CA644343163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse