1922894559 NPI number — MRS. KRISTEN VICTORIA RUTH RESPASS

Table of content: MRS. KRISTEN VICTORIA RUTH RESPASS (NPI 1922894559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922894559 NPI number — MRS. KRISTEN VICTORIA RUTH RESPASS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RESPASS
Provider First Name:
KRISTEN
Provider Middle Name:
VICTORIA RUTH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARNES
Provider Other First Name:
KRISTEN
Provider Other Middle Name:
VICTORIA RUTH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922894559
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
557 WINGED ELM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LORIS
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29569-7366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-414-7642
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 LEGION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONWAY
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29526-4825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-516-0455
Provider Business Practice Location Address Fax Number:
843-962-5277
Provider Enumeration Date:
04/18/2025

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: 101YP2500X , with the licence number:  A20991 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 10355 , 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: 697962 . This is a "CERTIFIED REHABILITATION COUNSELOR" identifier . This identifiers is of the category "OTHER".




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