Provider Demographics
NPI:1649976135
Name:PICKENS, KRISTINA M (APRN, CRNA)
Entity type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:M
Last Name:PICKENS
Suffix:
Gender:F
Credentials:APRN, CRNA
Other - Prefix:MS
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:KORTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN, CRNA
Mailing Address - Street 1:251 E HURON ST STE 5-704
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2908
Mailing Address - Country:US
Mailing Address - Phone:312-926-8369
Mailing Address - Fax:312-926-8341
Practice Address - Street 1:251 E HURON ST STE 5-704
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2908
Practice Address - Country:US
Practice Address - Phone:312-926-8369
Practice Address - Fax:312-926-8341
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041462975367500000X
IL209027904367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered