Provider Demographics
NPI:1043484579
Name:BRANDT, KRISTA K (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:K
Last Name:BRANDT
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LYSTER ARMY HEALTH CLINIC
Mailing Address - Street 2:BLDG 301 ANDREWS AVE
Mailing Address - City:FT RUCKER
Mailing Address - State:AL
Mailing Address - Zip Code:36362-5333
Mailing Address - Country:US
Mailing Address - Phone:334-255-7049
Mailing Address - Fax:334-255-7223
Practice Address - Street 1:LYSTER ARMY HEALTH CLINIC
Practice Address - Street 2:BLDG 301 ANDREWS AVE
Practice Address - City:FT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362-5333
Practice Address - Country:US
Practice Address - Phone:334-255-7049
Practice Address - Fax:334-255-7223
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-111423163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management