1356854194 NPI number — KRISTEN LEIGH ADDINGTON PA-C

Table of content: KRISTEN LEIGH ADDINGTON PA-C (NPI 1356854194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356854194 NPI number — KRISTEN LEIGH ADDINGTON PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADDINGTON
Provider First Name:
KRISTEN
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FORSTER
Provider Other First Name:
KRISTEN
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356854194
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
820 GALE LN
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:
37204-3012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-298-5406
Provider Business Mailing Address Fax Number:
615-747-1720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2717 MURFREESBORO PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANTIOCH
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37013-2003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-298-5406
Provider Business Practice Location Address Fax Number:
615-747-1720
Provider Enumeration Date:
11/15/2017

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: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Q035135 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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