Provider Demographics
NPI:1053606046
Name:BACA, KRISTA HILLARY (CRNA)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:HILLARY
Last Name:BACA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:HILLARY
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 94406
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-6706
Mailing Address - Country:US
Mailing Address - Phone:509-838-1547
Mailing Address - Fax:509-835-4058
Practice Address - Street 1:104 W 5TH AVE
Practice Address - Street 2:SUITE 250E
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-4880
Practice Address - Country:US
Practice Address - Phone:509-838-1547
Practice Address - Fax:509-835-4058
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00150367367500000X
WAAP60213659367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered