Provider Demographics
NPI:1730609736
Name:EMERY, KRISTA LYNN (RN)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:LYNN
Last Name:EMERY
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 1:13627 S BLOCK RD
Mailing Address - Street 2:
Mailing Address - City:BIRCH RUN
Mailing Address - State:MI
Mailing Address - Zip Code:48415-9484
Mailing Address - Country:US
Mailing Address - Phone:989-233-2289
Mailing Address - Fax:
Practice Address - Street 1:13627 BLOCK RD
Practice Address - Street 2:
Practice Address - City:BIRCH RUN
Practice Address - State:MI
Practice Address - Zip Code:48415
Practice Address - Country:US
Practice Address - Phone:989-233-2289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704223951163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse