Provider Demographics
NPI:1598933954
Name:CRIST, KEMBRA ANNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:KEMBRA
Middle Name:ANNE
Last Name:CRIST
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KEMBRA
Other - Middle Name:
Other - Last Name:CRIST
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1161
Mailing Address - Street 2:
Mailing Address - City:ANSTED
Mailing Address - State:WV
Mailing Address - Zip Code:25812-1161
Mailing Address - Country:US
Mailing Address - Phone:304-574-0239
Mailing Address - Fax:
Practice Address - Street 1:111 FAYETTE AVENUE
Practice Address - Street 2:FAYETTE COUNTY BOE
Practice Address - City:FAYETTEVILLE
Practice Address - State:WV
Practice Address - Zip Code:25840
Practice Address - Country:US
Practice Address - Phone:304-574-1176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV33504163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse