Provider Demographics
NPI:1245516798
Name:RISKA, KRISTAL MILLS (AUD, PHD)
Entity type:Individual
Prefix:
First Name:KRISTAL
Middle Name:MILLS
Last Name:RISKA
Suffix:
Gender:F
Credentials:AUD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JAMES H. QUILLEN/VA MEDICAL CENTER
Mailing Address - Street 2:BLDG 69 (AUDIOLOGY (126)
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684
Mailing Address - Country:US
Mailing Address - Phone:423-926-1171
Mailing Address - Fax:
Practice Address - Street 1:JAMES H QUILLEN VA MEDICAL CENTER /LAMONT STREET
Practice Address - Street 2:BLDG 69--AUDIOLOGY 126
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9712231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7413694Medicaid
NCQ38361AMedicare PIN