MEDICARE: MISS KRISTA A KILLINS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	26NO10750400	NJ

General Provider Information

NPI Number	:	1134100977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KRISTA A KILLINS RN

Provider Business Mailing Address
First Line	:	176 BROAD ST
Second Line	:
City	:	EATONTOWN
State	:	NJ
Zip	:	07724-1504
Country	:	US
Telephone Number	:	732-544-0968
Fax Number	:

Provider Business Practice Location Address
First Line	:	PATTERSON ARMY HEALTH CLINIC
Second Line	:	BLDG 1075 STEPHENSON AVE-FT MONMOUTH
City	:	EATONTOWN
State	:	NJ
Zip	:	07703
Country	:	US
Telephone Number	:	732-532-1244
Fax Number	:	732-532-6586

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	07/08/2007

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