Provider Demographics
NPI:1689848905
Name:SUMMERFELT, KRISTIN RUTH (RN, PHN)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:RUTH
Last Name:SUMMERFELT
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BODIN CIRCLE
Mailing Address - Street 2:BLDG 777
Mailing Address - City:TRAVIS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:94535
Mailing Address - Country:US
Mailing Address - Phone:707-423-7686
Mailing Address - Fax:707-423-5137
Practice Address - Street 1:101 BODIN CIR
Practice Address - Street 2:BLDG 777
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535-1809
Practice Address - Country:US
Practice Address - Phone:707-423-7686
Practice Address - Fax:707-423-5137
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA715178163W00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163W00000XNursing Service ProvidersRegistered Nurse