1821459009 NPI number — KRISTEN MCTERNAN A.T.C

Table of content: KRISTEN MCTERNAN A.T.C (NPI 1821459009)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821459009 NPI number — KRISTEN MCTERNAN A.T.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCTERNAN
Provider First Name:
KRISTEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
A.T.C
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:
1821459009
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
421 N WOODLAND BLVD
Provider Second Line Business Mailing Address:
8317
Provider Business Mailing Address City Name:
DELAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32723-8300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-822-7167
Provider Business Mailing Address Fax Number:
386-738-6536

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
421 N WOODLAND BLVD
Provider Second Line Business Practice Location Address:
8317
Provider Business Practice Location Address City Name:
DELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32723-8300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-822-7167
Provider Business Practice Location Address Fax Number:
386-738-6536
Provider Enumeration Date:
03/15/2016

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: 2255A2300X , with the licence number:  AL4296 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AL4296 . This is a "ATHLETIC TRAINER FLORIDA LISCENSURE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com