Provider Demographics
NPI:1649083619
Name:PURDOM, KRISTINA (RN)
Entity type:Individual
Prefix:MISS
First Name:KRISTINA
Middle Name:
Last Name:PURDOM
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:PO BOX 1112
Mailing Address - Street 2:
Mailing Address - City:ST JOHN
Mailing Address - State:VI
Mailing Address - Zip Code:00831-1112
Mailing Address - Country:US
Mailing Address - Phone:206-399-2971
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 8312
Practice Address - Street 2:
Practice Address - City:ST JOHN
Practice Address - State:VI
Practice Address - Zip Code:00831-8312
Practice Address - Country:US
Practice Address - Phone:340-776-8311
Practice Address - Fax:340-693-9506
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI13190163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse