Provider Demographics
NPI:1306506753
Name:KNIES, KRISTA LYNN (FNP)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:LYNN
Last Name:KNIES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 SCOTT ROLEN DR
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-2700
Mailing Address - Country:US
Mailing Address - Phone:812-482-5656
Mailing Address - Fax:812-996-8155
Practice Address - Street 1:440 SCOTT ROLEN DR
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-2700
Practice Address - Country:US
Practice Address - Phone:812-482-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF10191347363LF0000X
IN71012127A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily