1225311012 NPI number — KRISTA MARIE FORD ARNP

Table of content: KRISTA MARIE FORD ARNP (NPI 1225311012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225311012 NPI number — KRISTA MARIE FORD ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORD
Provider First Name:
KRISTA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WIEDENHOEFT
Provider Other First Name:
KRISTA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225311012
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 COLLEGE OF NURSING BLDG
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IOWA CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52242-1117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-467-1256
Provider Business Mailing Address Fax Number:
319-384-0080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 NEWTON ROAD
Provider Second Line Business Practice Location Address:
101 CNB
Provider Business Practice Location Address City Name:
IOWA CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52242-5224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-467-1256
Provider Business Practice Location Address Fax Number:
319-384-0080
Provider Enumeration Date:
09/28/2011

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: 363LF0000X , with the licence number:  A116969 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1106080 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9204826 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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