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General NPI Number Information
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NPI Number | 1497655161
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Entity Type | Individual
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Provider Name | RYAN KRIST AGPCNP-BC
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Gender | Male
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Dates
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Enumeration Date | 11/06/2026
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Last Update Date | 11/06/2026
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Provider Practice Location Address
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Address Line | N79W15814 CHARLES CT
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-4209
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Country | US
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Telephone | 920-946-9405
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Fax |
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Provider Business Mailing Address
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Address Line | N79W15814 CHARLES CT
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-4209
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 19276-33
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License Number State | WI
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