Provider Demographics
NPI:1508336694
Name:FARR, KRISTA NICOLE
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:NICOLE
Last Name:FARR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-637 HALEKOU RD
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-1715
Mailing Address - Country:US
Mailing Address - Phone:760-449-6552
Mailing Address - Fax:
Practice Address - Street 1:45-955 KAMEHAMEHA HWY # 404-405
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3222
Practice Address - Country:US
Practice Address - Phone:808-247-2973
Practice Address - Fax:808-427-3472
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000OtherTRI-CARE