Provider Demographics
NPI:1538973896
Name:LARSEN, KRISTYN MARIE (MSN, RN, PHN, CPHQ)
Entity type:Individual
Prefix:MRS
First Name:KRISTYN
Middle Name:MARIE
Last Name:LARSEN
Suffix:
Gender:F
Credentials:MSN, RN, PHN, CPHQ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3931 LOMA DR
Mailing Address - Street 2:
Mailing Address - City:SHINGLE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95682-8795
Mailing Address - Country:US
Mailing Address - Phone:626-664-1164
Mailing Address - Fax:
Practice Address - Street 1:4212 MISSOURI FLAT RD
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-6269
Practice Address - Country:US
Practice Address - Phone:530-621-7700
Practice Address - Fax:530-621-7713
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA838794163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse