Provider Demographics
NPI:1821494154
Name:ROLLINS, KRYSTEN (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTEN
Middle Name:
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KRYS
Other - Middle Name:
Other - Last Name:ROLLINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:14 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2606
Mailing Address - Country:US
Mailing Address - Phone:708-383-0113
Mailing Address - Fax:
Practice Address - Street 1:14 LAKE ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2606
Practice Address - Country:US
Practice Address - Phone:708-383-0113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-13
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.012121363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily