Provider Demographics
NPI:1093012213
Name:CAREY, KRYSTAL D (FNP)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:D
Last Name:CAREY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3630
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86003-3630
Mailing Address - Country:US
Mailing Address - Phone:928-213-6121
Mailing Address - Fax:928-774-6687
Practice Address - Street 1:1 CLINIC ROAD
Practice Address - Street 2:
Practice Address - City:GRAND CANYON
Practice Address - State:AZ
Practice Address - Zip Code:86023-0000
Practice Address - Country:US
Practice Address - Phone:928-638-2551
Practice Address - Fax:928-638-2598
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3922363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily