Provider Demographics
NPI:1699759613
Name:MELVIN, KRISTAL CELESTE (CRNP)
Entity type:Individual
Prefix:
First Name:KRISTAL
Middle Name:CELESTE
Last Name:MELVIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KRISTAL
Other - Middle Name:
Other - Last Name:EAST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:311 LYON CREST LN NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-9748
Mailing Address - Country:US
Mailing Address - Phone:253-968-2289
Mailing Address - Fax:253-968-2559
Practice Address - Street 1:9040 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:804-519-0462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR092301363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily