Provider Demographics
NPI:1558172791
Name:KOLIADKO, KRISTINE VIRGINIA (FNP-BC)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:VIRGINIA
Last Name:KOLIADKO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 S REBECCA DR
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-9361
Mailing Address - Country:US
Mailing Address - Phone:907-232-2176
Mailing Address - Fax:
Practice Address - Street 1:829 S REBECCA DR
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-9361
Practice Address - Country:US
Practice Address - Phone:907-232-2176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK232291363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily