Provider Demographics
NPI:1326779489
Name:HOUSEHOLDER, KRISTI KING (APRN)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:KING
Last Name:HOUSEHOLDER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-8008
Mailing Address - Country:US
Mailing Address - Phone:850-401-9355
Mailing Address - Fax:
Practice Address - Street 1:10800 PANAMA CITY BEACH PKWY STE 100
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-2532
Practice Address - Country:US
Practice Address - Phone:850-249-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9502446163W00000X
FL11020460363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse