Provider Demographics
NPI:1427427178
Name:BOLLING, KRISTEN (FNP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:BOLLING
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6518 E LYONS AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99217-9700
Mailing Address - Country:US
Mailing Address - Phone:602-309-5630
Mailing Address - Fax:
Practice Address - Street 1:6518 E LYONS AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99217-9700
Practice Address - Country:US
Practice Address - Phone:602-309-5630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0992200363LF0000X
WY362971433363LF0000X
ID55634363LF0000X
WA60740480363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily