Basic Information
Provider Information
NPI: 1467705178
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ESTES
FirstName: KRYSTAN
MiddleName: MCCURRY
NamePrefix:  
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1149
Address2:  
City: NEBO
State: NC
PostalCode: 287610964
CountryCode: US
TelephoneNumber: 8286593418
FaxNumber: 8286593291
Practice Location
Address1: 1251 PINNACLE CHURCH ROAD
Address2:  
City: NEBO
State: NC
PostalCode: 287615753
CountryCode: US
TelephoneNumber: 8286593418
FaxNumber: 8286593291
Other Information
ProviderEnumerationDate: 10/18/2012
LastUpdateDate: 10/18/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X209746NCY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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