Provider Demographics
NPI:1366776155
Name:KING, KRISTINA ELIN (FNP-C)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ELIN
Last Name:KING
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CALLE DE LA VINA RD
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-4509
Mailing Address - Country:US
Mailing Address - Phone:413-265-6916
Mailing Address - Fax:413-931-3200
Practice Address - Street 1:400 CALLE DE LA VINA RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571
Practice Address - Country:US
Practice Address - Phone:413-265-6916
Practice Address - Fax:413-931-3200
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-25
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3461363LF0000X
MEAP111076363LF0000X
MARN2285633363LF0000X
NMCNP-03370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily