1306880422 NPI number — KRISTIN CONRAD CNM

Table of content: KRISTIN CONRAD CNM (NPI 1306880422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306880422 NPI number — KRISTIN CONRAD CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONRAD
Provider First Name:
KRISTIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306880422
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1997 S MAIN ST
Provider Second Line Business Mailing Address:
SUITE 704
Provider Business Mailing Address City Name:
BLACKSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24060-6635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-961-1058
Provider Business Mailing Address Fax Number:
540-961-1668

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 ELECTRIC RD STE 1030
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24153-7474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-774-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2006

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: 367A00000X , with the licence number:  0024167315 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367A00000X , with the licence number: 167478 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0024167315 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 98482548 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".