Provider Demographics
NPI:1821482142
Name:MCMULLEN, KRISTA L (LPN)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:L
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 WEST WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344
Mailing Address - Country:US
Mailing Address - Phone:850-342-0170
Mailing Address - Fax:850-342-0257
Practice Address - Street 1:1255 WEST WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344
Practice Address - Country:US
Practice Address - Phone:850-342-0170
Practice Address - Fax:850-342-0257
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN425281164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse