Individual
KRISTA FUQUA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1585 NW WASHINGTON BLVD, GRANTS PASS, OR 97526-1049
(541) 474-5511
Mailing address
PO BOX 99371, FORT WORTH, TX 76199-0371
(682) 885-1855
(682) 885-7347
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
201606762NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
718569
LICENSE
TX
Enumeration date
11/20/2013
Last updated
08/12/2021
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