Provider Demographics
NPI:1760935183
Name:ANDERSON, KRISTA JO (RN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:JO
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:JO
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 FITHIAN DR
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-3208
Mailing Address - Country:US
Mailing Address - Phone:239-247-1170
Mailing Address - Fax:
Practice Address - Street 1:24 FITHIAN DR
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-3208
Practice Address - Country:US
Practice Address - Phone:239-247-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL2-0044863163W00000X
FLRN9296238163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse