Provider Demographics
NPI:1720814635
Name:HANSON, KRISTY L (NP-C)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:L
Last Name:HANSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:61477-0044
Mailing Address - Country:US
Mailing Address - Phone:309-338-7709
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 44
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:IL
Practice Address - Zip Code:61477-0044
Practice Address - Country:US
Practice Address - Phone:309-338-7709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209030211363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily