1053639294 NPI number — MRS. KRISTIN NICHOLE ESTOK

Table of content: MRS. KRISTIN NICHOLE ESTOK (NPI 1053639294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053639294 NPI number — MRS. KRISTIN NICHOLE ESTOK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESTOK
Provider First Name:
KRISTIN
Provider Middle Name:
NICHOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FARLEY
Provider Other First Name:
KRISTIN
Provider Other Middle Name:
NICHOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053639294
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3405 HARBORWOOD CIRCLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-500-7435
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3310 PERIMETER HILL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-250-7200
Provider Business Practice Location Address Fax Number:
615-250-7281
Provider Enumeration Date:
05/12/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)