Provider Demographics
NPI:1982618914
Name:ZAK, KRISTY WINKLER (CRNA)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:WINKLER
Last Name:ZAK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 GREYSTONE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-2290
Mailing Address - Country:US
Mailing Address - Phone:304-342-2036
Mailing Address - Fax:
Practice Address - Street 1:CAMC / WOMAN AND CHILDRENS DIVISION
Practice Address - Street 2:800 PENNSYLVANIA AVE.
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302
Practice Address - Country:US
Practice Address - Phone:304-342-2036
Practice Address - Fax:304-388-3697
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV28133367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered