DEANNA JANE KRISTOFIC, PMHNP — NPI 1013207489 (Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric

CMS-1500 Box 24J / 33a • NPI

1013207489

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

363LP0808X (CMS 50)

Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health

Box 32 Service Location & ZIP+4

167 NORTH MAIN STREET, TUBA CITY, AZ, 86045-0600

✓ 9-Digit EDI 837 ZIP+4 (86045-0600)

Practice Phone & Referral Fax

(928) 283-2501

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1013207489 (DEANNA JANE KRISTOFIC, PMHNP) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1013207489` (NPI-1 Individual Practitioner)
Provider / Legal Name	DEANNA JANE KRISTOFIC, PMHNP
Plain-English Specialty	Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health NUCC Code: `363LP0808X` (Nurse Practitioner, Psych/Mental Health)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	167 NORTH MAIN STREET, TUBA CITY, AZ, 86045-0600
Practice Telephone / Fax	Tel: (928) 283-2501
Administrative Mailing Address	4680 ABLE AVE, KANAB, UT, 84741-8161
Enumeration & Last Sync	Enumerated: 2011-04-19 \| CMS Record Updated: 2012-01-26

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

167 NORTH MAIN STREET, TUBA CITY, AZ, 86045-0600

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Plain-English Taxonomy & CMS Crosswalk (363LP0808X)

What Does Taxonomy Code 363LP0808X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363LP0808X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 50 (Nurse Practitioner)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Nurse Practitioner, Psych/Mental Health for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (DEANNA JANE KRISTOFIC, PMHNP)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`363LP0808X` — Nurse Practitioner, Psych/Mental Health Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health	State: AZ \| License: `AP4267` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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DEANNA JANE KRISTOFIC, PMHNP (NPI #1013207489)