Provider Demographics
NPI:1659916203
Name:PAULL, KRISTI RAE (FNP)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:RAE
Last Name:PAULL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 CIDERMILL RD
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-9270
Mailing Address - Country:US
Mailing Address - Phone:219-898-8509
Mailing Address - Fax:
Practice Address - Street 1:1668 S US HIGHWAY 421
Practice Address - Street 2:
Practice Address - City:WESTVILLE
Practice Address - State:IN
Practice Address - Zip Code:46391-9523
Practice Address - Country:US
Practice Address - Phone:219-785-8424
Practice Address - Fax:888-692-8982
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71009499363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily