1164498382 NPI number — MRS. KRISTI H ROLAND DPT

Table of content: MRS. KRISTI H ROLAND DPT (NPI 1164498382)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164498382 NPI number — MRS. KRISTI H ROLAND DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROLAND
Provider First Name:
KRISTI
Provider Middle Name:
H
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOLANCIN
Provider Other First Name:
KRISTI
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164498382
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
114 CAPTAINS CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSONVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37075-6732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-859-0351
Provider Business Mailing Address Fax Number:
615-859-0354

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2021 GALLATIN PIKE N
Provider Second Line Business Practice Location Address:
SUITE 248
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37115-2097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-859-0351
Provider Business Practice Location Address Fax Number:
615-859-0354
Provider Enumeration Date:
02/27/2006

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: 2251X0800X , with the licence number:  PT7382 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3646335 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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