1477718856 NPI number — KRISTI KAE LIND WHEATLEY PMHNP-BC

Table of content: DR. JOHN PAUL VELASCO M.D. (NPI 1598029704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477718856 NPI number — KRISTI KAE LIND WHEATLEY PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIND WHEATLEY
Provider First Name:
KRISTI
Provider Middle Name:
KAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PMHNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477718856
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 2ND ST W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARK RAPIDS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56470-1506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-237-5860
Provider Business Mailing Address Fax Number:
218-237-5861

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 2ND ST W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARK RAPIDS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56470-1506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-237-5860
Provider Business Practice Location Address Fax Number:
218-237-5861
Provider Enumeration Date:
07/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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