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1104509447 NPI number — KRISTA MELODY BOONE LMSW

NPI Number: 1104509447
Health Care Provider/Practitioner: KRISTA MELODY BOONE LMSW

Information about “1104509447” NPI (KRISTA MELODY BOONE LMSW) exists in 1104509447 in HTML format HTML  |  1104509447 in plain Text format TXT  |  1104509447 in PDF (Portable Document Format) PDF  |  1104509447 in an XML format XML  formats.

NPI Number : 1104509447 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104509447",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BOONE",
    "FirstName": "KRISTA",
    "MiddleName": "MELODY",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LMSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "315 WENDELL AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FAIRBANKS",
    "MailingAddressStateName": "AK",
    "MailingAddressPostalCode": "99701-4837",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "907-450-3400",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "399 HELMERICKS AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FAIRBANKS",
    "PracticeLocationAddressStateName": "AK",
    "PracticeLocationAddressPostalCode": "99701-3180",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "907-450-3400",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/11/2023",
    "LastUpdateDate": "07/28/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "172V00000X",
        "TaxonomyName": "Community Health Worker",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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