Provider Demographics
NPI:1417983164
Name:FALCON, MISTY K (NP)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:K
Last Name:FALCON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:K
Other - Last Name:CARRINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 4TH ST E
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-5350
Mailing Address - Country:US
Mailing Address - Phone:701-577-9255
Mailing Address - Fax:701-577-2881
Practice Address - Street 1:3 4TH ST E
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-5350
Practice Address - Country:US
Practice Address - Phone:701-577-9255
Practice Address - Fax:701-577-2881
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO171311363L00000X
NDR26168363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71038710Medicaid
CO71038710Medicaid