Provider Demographics
NPI:1689928558
Name:PRATT, KRISTINIA (MHPP, RN)
Entity Type:Individual
Prefix:
First Name:KRISTINIA
Middle Name:
Last Name:PRATT
Suffix:
Gender:F
Credentials:MHPP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 ELM STREET
Mailing Address - Street 2:
Mailing Address - City:TUCKERMAN
Mailing Address - State:AR
Mailing Address - Zip Code:72473
Mailing Address - Country:US
Mailing Address - Phone:870-349-1313
Mailing Address - Fax:870-349-1311
Practice Address - Street 1:102 ELM STREET
Practice Address - Street 2:
Practice Address - City:TUCKERMAN
Practice Address - State:AR
Practice Address - Zip Code:72473
Practice Address - Country:US
Practice Address - Phone:870-349-1313
Practice Address - Fax:870-349-1311
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR087658163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management