Provider Demographics
NPI:1619632932
Name:WHEELER, KRISTIE NICOLE (LPN)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:NICOLE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KRISTIE
Other - Middle Name:NICOLE
Other - Last Name:SPICKARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:3208 HERSHBERGER RD NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24017-1842
Mailing Address - Country:US
Mailing Address - Phone:540-202-2393
Mailing Address - Fax:540-366-5211
Practice Address - Street 1:3208 HERSHBERGER RD NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24017-1842
Practice Address - Country:US
Practice Address - Phone:540-202-2393
Practice Address - Fax:540-366-5211
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002083553164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse