Provider Demographics
NPI:1063195394
Name:BRACKLEY, CRISTA (RN)
Entity type:Individual
Prefix:
First Name:CRISTA
Middle Name:
Last Name:BRACKLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2366 GOLDEN MILE HWY
Mailing Address - Street 2:PMB 253
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15239
Mailing Address - Country:US
Mailing Address - Phone:412-897-5782
Mailing Address - Fax:
Practice Address - Street 1:615 ALPHA DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-2832
Practice Address - Country:US
Practice Address - Phone:412-820-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN582041163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)