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NPI Code Detail

MEDICARE: KRISTA FAULKNER LLMSW

MEDICARE: KRISTA FAULKNER LLMSW
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
11041C0700XClinical Social Worker6851121444MI

General Provider Information

NPI Number : 1891549721
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTA FAULKNER LLMSW
Provider Business Mailing Address
First Line : 3111 ELECTRIC AVE
Second Line :
City : PORT HURON
State : MI
Zip : 48060-8127
Country : US
Telephone Number : 810-985-8900
Fax Number :
Provider Business Practice Location Address
First Line : 2415 24TH ST
Second Line :
City : PORT HURON
State : MI
Zip : 48060-6414
Country : US
Telephone Number : 810-488-8840
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2024
Last Update Date : 02/02/2026

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