Provider Demographics
NPI:1104509447
Name:BOONE, KRISTA MELODY (LMSW)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:MELODY
Last Name:BOONE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 WENDELL AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4837
Mailing Address - Country:US
Mailing Address - Phone:907-450-3400
Mailing Address - Fax:
Practice Address - Street 1:399 HELMERICKS AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3180
Practice Address - Country:US
Practice Address - Phone:907-450-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker