Provider Demographics
NPI:1518520733
Name:SCROGGIN, KRISTIE JO (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:JO
Last Name:SCROGGIN
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 1:2345 E PRATER WAY STE 207
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-9634
Mailing Address - Country:US
Mailing Address - Phone:725-333-8400
Mailing Address - Fax:
Practice Address - Street 1:1389 GALLERIA DR STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6686
Practice Address - Country:US
Practice Address - Phone:725-333-8400
Practice Address - Fax:725-333-8401
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV820037363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily