Provider Demographics
NPI:1992583249
Name:TARRELL, KRISTEN NOELLE (RN)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:NOELLE
Last Name:TARRELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:CONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:909 RICHLAND RD SPC 126
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-9637
Mailing Address - Country:US
Mailing Address - Phone:916-532-7516
Mailing Address - Fax:
Practice Address - Street 1:909 RICHLAND RD SPC 126
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-9637
Practice Address - Country:US
Practice Address - Phone:916-532-7516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA502859163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA502859OtherCALIFORNIA BOARD OF REGISTERED NURSING
CA75527OtherCALIFORNIA BOARD OF REGISTERED NURSING