Healthcare Provider Details

I. General information

NPI: 1003004144
Provider Name (Legal Business Name): KRISTELL L MICHAEL APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US AIR FORCE 377 MDG/SGHC 2050A SECOND STREET SE
ALBUQUERQUE NM
87117-6027
US

IV. Provider business mailing address

377 MDG/SGHC 2050A SECOND STREET SE
ALBUQUERQUE NM
87117-5522
US

V. Phone/Fax

Practice location:
  • Phone: 505-846-3562
  • Fax: 334-953-8607
Mailing address:
  • Phone: 505-846-3562
  • Fax: 334-953-8607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number558669
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: