Provider Demographics
NPI:1033092283
Name:RUSSELL, KRISTA (RN)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 W STATE ROUTE 89A UNIT 2734
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-6135
Mailing Address - Country:US
Mailing Address - Phone:480-580-2024
Mailing Address - Fax:
Practice Address - Street 1:190 W STATE ROUTE 89A UNIT 2734
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-6135
Practice Address - Country:US
Practice Address - Phone:480-580-2024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN101071163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)