Healthcare Provider Details

I. General information

NPI: 1982254017
Provider Name (Legal Business Name): KRISTINA WESTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10134 NW TUCKER RD
ALTHA FL
32421-2424
US

IV. Provider business mailing address

10134 NW TUCKER RD
ALTHA FL
32421-2424
US

V. Phone/Fax

Practice location:
  • Phone: 850-693-0646
  • Fax:
Mailing address:
  • Phone: 850-693-0646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: