Healthcare Provider Details

I. General information

NPI: 1508336694
Provider Name (Legal Business Name): KRISTA NICOLE FARR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45-955 KAMEHAMEHA HWY # 404-405
KANEOHE HI
96744-3222
US

IV. Provider business mailing address

45-637 HALEKOU RD
KANEOHE HI
96744-1715
US

V. Phone/Fax

Practice location:
  • Phone: 808-247-2973
  • Fax: 808-427-3472
Mailing address:
  • Phone: 760-449-6552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: