Provider Demographics
NPI:1609809052
Name:WISTER, KIRSTEN ELIZABETH (FNP-BC, ACNP-BC)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:ELIZABETH
Last Name:WISTER
Suffix:
Gender:F
Credentials:FNP-BC, ACNP-BC
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:ELIZABETH
Other - Last Name:WHITMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4996 E MEDITERRANEAN DR STE D
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2434
Mailing Address - Country:US
Mailing Address - Phone:520-335-6271
Mailing Address - Fax:520-335-6316
Practice Address - Street 1:4996 E MEDITERRANEAN DR STE D
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2434
Practice Address - Country:US
Practice Address - Phone:520-335-6271
Practice Address - Fax:520-335-6316
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2534363LA2100X
AZAP3956363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ610600Medicaid
AZ610600Medicaid