Provider Demographics
NPI:1235963679
Name:CRITICAL CARE NURSE CONSULTANTS
Entity type:Organization
Organization Name:CRITICAL CARE NURSE CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELI
Authorized Official - Middle Name:R
Authorized Official - Last Name:HESKETT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:928-951-2055
Mailing Address - Street 1:23360 BRIDLE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LINDALE
Mailing Address - State:TX
Mailing Address - Zip Code:75771-5511
Mailing Address - Country:US
Mailing Address - Phone:575-993-2143
Mailing Address - Fax:
Practice Address - Street 1:23360 BRIDLE VIEW DR
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-5511
Practice Address - Country:US
Practice Address - Phone:575-443-2143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1508583824Medicaid
UT1114636115Medicaid