Provider Demographics
NPI:1447096136
Name:MCCORMICK, KRISTI LYNN (FNP-C)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:LYNN
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8988 E US HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:NEW CARLISLE
Mailing Address - State:IN
Mailing Address - Zip Code:46552-9038
Mailing Address - Country:US
Mailing Address - Phone:574-654-7779
Mailing Address - Fax:
Practice Address - Street 1:8988 E US HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:NEW CARLISLE
Practice Address - State:IN
Practice Address - Zip Code:46552-9038
Practice Address - Country:US
Practice Address - Phone:574-654-7779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71015455A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty