Provider Demographics
NPI:1427875822
Name:TKACH, KRYSTAL LEE (CNA)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:LEE
Last Name:TKACH
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4306
Mailing Address - Country:US
Mailing Address - Phone:701-595-4875
Mailing Address - Fax:
Practice Address - Street 1:823 N 12TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4306
Practice Address - Country:US
Practice Address - Phone:701-595-4875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant