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General NPI Number Information
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NPI Number | 1689646622
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Entity Type | Individual
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Provider Name | KJELL O KRISTIANSEN CRNA
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Gender | Male
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Dates
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Enumeration Date | 02/03/2006
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Last Update Date | 04/04/2008
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Provider Practice Location Address
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Address Line | 520 W 1ST ST
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City | NEW ALBANY
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State | IN
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Zip | 47150-3603
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Country | US
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Telephone | 812-949-3442
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Fax | 812-949-3441
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Provider Business Mailing Address
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Address Line | 520 W 1ST ST
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City | NEW ALBANY
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State | IN
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Zip | 47150-3603
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Country | US
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Telephone | 812-949-3442
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Fax | 812-949-3441
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 501A
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License Number State | KY
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