Provider Demographics
NPI:1912911520
Name:CONN, KRISTA BELLE (LVN)
Entity type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:BELLE
Last Name:CONN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 CARRIZO GORGE RD # R-7
Mailing Address - Street 2:
Mailing Address - City:JACUMBA
Mailing Address - State:CA
Mailing Address - Zip Code:91934-2142
Mailing Address - Country:US
Mailing Address - Phone:603-412-2257
Mailing Address - Fax:
Practice Address - Street 1:200 S 5TH ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3013
Practice Address - Country:US
Practice Address - Phone:760-482-0864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN747538164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse