Healthcare Provider Details

I. General information

NPI: 1710523568
Provider Name (Legal Business Name): KRISTOFER ALSTON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2019
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 STEELHAMMER DR
CENTRALIA WA
98531-1532
US

IV. Provider business mailing address

2428 W REYNOLDS AVE
CENTRALIA WA
98531-4554
US

V. Phone/Fax

Practice location:
  • Phone: 360-623-8020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN60878817
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: