Basic Information
Provider Information
NPI: 1881163046
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TRAFELET
FirstName: KRISTINA
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: FNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 117287
Address2:  
City: ATLANTA
State: GA
PostalCode: 303687287
CountryCode: US
TelephoneNumber: 2394328331
FaxNumber: 8133211296
Practice Location
Address1: 1876 E SABIN DR STE 10
Address2:  
City: CASA GRANDE
State: AZ
PostalCode: 851226197
CountryCode: US
TelephoneNumber: 5208369800
FaxNumber: 5208361510
Other Information
ProviderEnumerationDate: 11/17/2018
LastUpdateDate: 10/07/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/07/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X218409AZY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


Home