Provider Demographics
NPI:1619677341
Name:ELDER, KRISTA NICHOLE (HHA, SSD, CNA, MHLC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:NICHOLE
Last Name:ELDER
Suffix:
Gender:F
Credentials:HHA, SSD, CNA, MHLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S 11TH ST APT 316
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64503-2574
Mailing Address - Country:US
Mailing Address - Phone:913-426-6563
Mailing Address - Fax:
Practice Address - Street 1:800 RAVENHILL DR
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-9204
Practice Address - Country:US
Practice Address - Phone:913-246-2877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator