Provider Demographics
NPI:1326024548
Name:JACQUES, KRISTA DEANN (APRN, BC)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:DEANN
Last Name:JACQUES
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:D
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, BC
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:2613 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-4030
Practice Address - Country:US
Practice Address - Phone:573-642-1990
Practice Address - Fax:573-642-5089
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0100167-C-NP363LF0000X
MO113720363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily