Provider Demographics
NPI:1477718856
Name:LIND WHEATLEY, KRISTI KAE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:KAE
Last Name:LIND WHEATLEY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 2ND ST W
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-1506
Mailing Address - Country:US
Mailing Address - Phone:218-237-5860
Mailing Address - Fax:218-237-5861
Practice Address - Street 1:205 2ND ST W
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1506
Practice Address - Country:US
Practice Address - Phone:218-237-5860
Practice Address - Fax:218-237-5861
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN410901540Medicare UPIN