Provider Demographics
NPI:1144758848
Name:MIRACLE, KRISTA LYNN (DEM)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:LYNN
Last Name:MIRACLE
Suffix:
Gender:F
Credentials:DEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 S 1100 W
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-5003
Mailing Address - Country:US
Mailing Address - Phone:801-923-8806
Mailing Address - Fax:
Practice Address - Street 1:473 S 1100 W
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-5003
Practice Address - Country:US
Practice Address - Phone:801-923-8806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty