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General NPI Number Information
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NPI Number | 1811225717
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Entity Type | Individual
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Provider Name | KRISTI JO NISSLEY FNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/03/2009
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Last Update Date | 07/24/2024
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Provider Practice Location Address
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Address Line | 2759 STATE ROAD 37
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City | MITCHELL
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State | IN
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Zip | 47446
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Country | US
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Telephone | 812-849-6420
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Fax |
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Provider Business Mailing Address
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Address Line | 2759 STATE ROAD 37
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City | MITCHELL
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State | IN
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Zip | 47446-6016
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Country | US
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Telephone | 812-992-5440
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Fax | 812-992-5441
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71003156A
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License Number State | IN
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