Provider Demographics
NPI:1134865561
Name:KIRCHEN, CHRISTINA JACKLYN (CNP)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JACKLYN
Last Name:KIRCHEN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:CHISHOLM
Mailing Address - State:MN
Mailing Address - Zip Code:55719-1819
Mailing Address - Country:US
Mailing Address - Phone:218-254-0101
Mailing Address - Fax:
Practice Address - Street 1:118 W LAKE ST
Practice Address - Street 2:
Practice Address - City:CHISHOLM
Practice Address - State:MN
Practice Address - Zip Code:55719-1819
Practice Address - Country:US
Practice Address - Phone:218-343-0515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2295279163W00000X
MN229527363LP0808X
MN9380363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse