Healthcare Provider Details

I. General information

NPI: 1023667516
Provider Name (Legal Business Name): KRISTI M LORD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9190 AUGUST CIR
ST AUGUSTINE FL
32080-8626
US

IV. Provider business mailing address

9190 AUGUST CIR
ST AUGUSTINE FL
32080-8626
US

V. Phone/Fax

Practice location:
  • Phone: 352-650-3446
  • Fax: 904-341-5529
Mailing address:
  • Phone: 352-650-3446
  • Fax: 904-341-5529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number11004025
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11004025
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: