| Krystal Kay Lavine, | |
|
114 N Washington St, Bourbon, IN 46504-1623 | |
| (574) 335-7850 | |
| (574) 335-0755 |
| Full Name | Krystal Kay Lavine |
|---|---|
| Gender | Female |
| Speciality | Nurse Practitioner |
| Experience | 9 Years |
| Location | 114 N Washington St, Bourbon, Indiana |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821586207 | NPI | - | NPPES |
| 300020124 | Medicaid | IN | |
| 1102236362 | Other | IN | ANTHEM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363LF0000X | Nurse Practitioner - Family | 71008330A (Indiana) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Saint Joseph Regional Medical Center - Plymouth | Plymouth, IN | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Saint Joseph Regional Medical Center Inc | 8325950843 | 126 |
| Entity Name | Saint Joseph Regional Medical Center Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1225082878 PECOS PAC ID: 8325950843 Enrollment ID: O20040708000757 |
| Mailing Address | Practice Location Address |
|---|---|
| Krystal Kay Lavine, 5215 Holy Cross Pkwy, Mishawaka, IN 46545-1469 Ph: () - | Krystal Kay Lavine, 114 N Washington St, Bourbon, IN 46504-1623 Ph: (574) 335-7850 |
Mrs. Jennifer Robyn Friberg, N.P. Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 114 N Washington St, Bourbon, IN 46504 Phone: 574-335-7850 Fax: 574-335-0755 | |
Mrs. Barbara Jane Kunnen, MS, RN, FNP-C Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 114 N Washington St, Bourbon, IN 46504 Phone: 574-335-7850 Fax: 574-335-0755 |