Provider Demographics
NPI:1407855018
Name:DILWORTH, KRISTINA NELSON (RN, MS, FNP, ADM)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:NELSON
Last Name:DILWORTH
Suffix:
Gender:F
Credentials:RN, MS, FNP, ADM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 CASA ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1818
Mailing Address - Country:US
Mailing Address - Phone:805-541-1422
Mailing Address - Fax:805-595-1815
Practice Address - Street 1:35 CASA ST
Practice Address - Street 2:SUITE 130
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1818
Practice Address - Country:US
Practice Address - Phone:805-541-1422
Practice Address - Fax:805-595-1815
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA336369363L00000X
CA0350311-22363LF0000X
CA2051-0093163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
P61781Medicare UPIN
CAWNP11572CMedicare ID - Type Unspecified