Provider Demographics
NPI:1063685741
Name:HEATHERSTONE, KRISTI GAIL (LAC, MAC)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:GAIL
Last Name:HEATHERSTONE
Suffix:
Gender:F
Credentials:LAC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1160
Mailing Address - Country:US
Mailing Address - Phone:541-482-5180
Mailing Address - Fax:541-482-5180
Practice Address - Street 1:534 WASHINGTON ST
Practice Address - Street 2:SUITE #8
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1682
Practice Address - Country:US
Practice Address - Phone:541-482-3180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01166171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist