Provider Demographics
NPI:1558006288
Name:CRUMP, KRISTINA (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:
Last Name:CRUMP
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40020 TESORO LN
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3575
Mailing Address - Country:US
Mailing Address - Phone:661-965-4101
Mailing Address - Fax:
Practice Address - Street 1:1120 W AVENUE M4
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1432
Practice Address - Country:US
Practice Address - Phone:661-480-2377
Practice Address - Fax:661-480-2378
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020107363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily