Provider Demographics
NPI:1992585830
Name:BENNETT, KRISTA RENEE (ND, LAC)
Entity type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:RENEE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 KALA SQUARE PL STE 2
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-9810
Mailing Address - Country:US
Mailing Address - Phone:360-390-5844
Mailing Address - Fax:
Practice Address - Street 1:112 KALA SQUARE PL STE 2
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-9810
Practice Address - Country:US
Practice Address - Phone:360-390-5844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA171100000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist