Provider Demographics
NPI:1205219169
Name:DURBIN, KRISTA L (NP)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:L
Last Name:DURBIN
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 HIGH ST PO BOX 466
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:IN
Mailing Address - Zip Code:46783
Mailing Address - Country:US
Mailing Address - Phone:260-452-8861
Mailing Address - Fax:
Practice Address - Street 1:164 HIGH ST
Practice Address - Street 2:PO BOX 466
Practice Address - City:ROANOKE
Practice Address - State:IN
Practice Address - Zip Code:46783
Practice Address - Country:US
Practice Address - Phone:260-452-8861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005572A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily