Provider Demographics
NPI:1699443515
Name:CAREY, KRYSTAL LYNN (NP)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:LYNN
Last Name:CAREY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 E NARDINI ST
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-6822
Mailing Address - Country:US
Mailing Address - Phone:480-868-7193
Mailing Address - Fax:
Practice Address - Street 1:1402 E NARDINI ST
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-6822
Practice Address - Country:US
Practice Address - Phone:480-868-7193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZF06211318363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF06211318OtherAANP
AZ261065OtherSTATE BOARD OF NURSING
AZ261065OtherSTATE BOARD OF NURSING