Provider Demographics
NPI:1073057188
Name:PAHL, KRISTIN (RPA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:PAHL
Suffix:
Gender:F
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6836 MORRISON BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2612
Mailing Address - Country:US
Mailing Address - Phone:704-817-0821
Mailing Address - Fax:704-817-0835
Practice Address - Street 1:6836 MORRISON BLVD STE 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2612
Practice Address - Country:US
Practice Address - Phone:704-817-0821
Practice Address - Fax:704-817-0835
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16RRASC1002243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant