1568402337 NPI number — DR. KRISTI LYNN BLESSITT M.D.

Table of content: DR. KRISTI LYNN BLESSITT M.D. (NPI 1568402337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568402337 NPI number — DR. KRISTI LYNN BLESSITT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLESSITT
Provider First Name:
KRISTI
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1568402337
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 280
Provider Second Line Business Mailing Address:
29 PLANTATION PARK DRIVE, SUITE 204
Provider Business Mailing Address City Name:
BLUFFTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-715-0570
Provider Business Mailing Address Fax Number:
843-715-0570

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29 PLANTATION PARK DRIVE
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
BLUFFTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-715-0570
Provider Business Practice Location Address Fax Number:
843-715-0570
Provider Enumeration Date:
06/08/2006

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: 174400000X , with the licence number:  18138 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: TL30791 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 09333019 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09333019 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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