Provider Demographics
NPI:1881766269
Name:GARZA, KRISTA MARIA (NP)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:MARIA
Last Name:GARZA
Suffix:
Gender:F
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:1720 W BROADWAY STE 107
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-3607
Practice Address - Country:US
Practice Address - Phone:502-340-5900
Practice Address - Fax:502-394-3691
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002276A363LA2200X
KY2881P363LA2200X
KY3002881363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY099673OtherSIHO- NORTON LOUISVILLE PRIMARY CARE CENTER
KY3580654000OtherPASSPORT ADVANTAGE- NORTON LOUISVILLE PRIMARY CARE CENTER
KY0042311OtherMEDICARE- NORTON LOUISVILLE PRIMARY CARE CENTER
KY78028818Medicaid
KY000000587866OtherANTHEM- NORTON LOUISVILLE PRIMARY CARE CENTER
IN200843440Medicaid
KYP00768853OtherRAILROAD MEDICARE- NORTON LOUISVILLE PRIMARY CARE CENTER
KY610978438SOtherHUMANA- NORTON LOUISVILLE PRIMARY CARE CENTER
KY000000520227OtherANTHEM
KY50021568OtherPASSPORT- NORTON LOUISVILLE PRIMARY CARE CENTER
KY0042311OtherMEDICARE- NORTON LOUISVILLE PRIMARY CARE CENTER
IN200843440Medicaid
KYP00451261Medicare PIN
KY000000520227OtherANTHEM
KY78028818Medicaid