Provider Demographics
NPI:1164726972
Name:TRUESDALE, KRISTY (CLC)
Entity Type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:
Last Name:TRUESDALE
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1191 S JOPLIN ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-4025
Mailing Address - Country:US
Mailing Address - Phone:303-719-1922
Mailing Address - Fax:
Practice Address - Street 1:1191 S JOPLIN ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-4025
Practice Address - Country:US
Practice Address - Phone:303-719-1922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
CO27873174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN