Provider Demographics
NPI:1891489886
Name:WHITEHEAD, KRYSTEN TAYLOR (APRN FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTEN
Middle Name:TAYLOR
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11303 LINCK RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-6842
Mailing Address - Country:US
Mailing Address - Phone:618-694-9515
Mailing Address - Fax:
Practice Address - Street 1:909 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:62896-2209
Practice Address - Country:US
Practice Address - Phone:618-372-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209027592363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner