Provider Demographics
NPI:1285072264
Name:PREY, KRISTIN NICOLE (ARNP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:NICOLE
Last Name:PREY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:NICOLE
Other - Last Name:NOONER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:5261 CARROLLTON PIKE STE A
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:VA
Mailing Address - Zip Code:24381-3034
Mailing Address - Country:US
Mailing Address - Phone:360-880-8193
Mailing Address - Fax:509-418-5789
Practice Address - Street 1:9106 W RUTTER PKWY
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-9210
Practice Address - Country:US
Practice Address - Phone:509-418-4248
Practice Address - Fax:509-418-0402
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60367676363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily