Provider Demographics
NPI:1003904392
Name:QUESENBERRY, KRISTIN MARIE (MS)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:MARIE
Last Name:QUESENBERRY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:KRISTIN
Other - Middle Name:MARIE
Other - Last Name:LENNEX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:243 A NEFF AVENUE
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3482
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:243 A NEFF AVENUE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3482
Practice Address - Country:US
Practice Address - Phone:540-432-0071
Practice Address - Fax:540-432-6079
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001295231H00000X
VA2101001509237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA49486OtherOPTIMA
VA118844OtherOPTIMA
VA148358OtherSOUTHERN HEALTH SERV
VA49486OtherOPTIMA
Q58644Medicare UPIN