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Individual

KRISTA SHAMBAUGH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PMHNP

Contact information

Practice address
4060 FAIRMOUNT AVE, SAN DIEGO, CA 92105-1608
(619) 280-4213
Mailing address
4060 FAIRMOUNT AVE, SAN DIEGO, CA 92105-1608
(619) 280-4213

Taxonomy

Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
95097866
CA
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
95097866
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95031769
CA

Other

Enumeration date
10/13/2016
Last updated
10/09/2024
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