Provider Demographics
NPI:1851098115
Name:SKINNER, KRYSTAL DANAE (PMHNP)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:DANAE
Last Name:SKINNER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:DANAE
Other - Last Name:HORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:405 E BEALE ST
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-5833
Mailing Address - Country:US
Mailing Address - Phone:928-723-3354
Mailing Address - Fax:
Practice Address - Street 1:405 E BEALE ST
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-5833
Practice Address - Country:US
Practice Address - Phone:928-723-3354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ287274363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty