Provider Demographics
NPI:1073107439
Name:MARTIN, KRISTEN NICOLE (CBD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:NICOLE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CBD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 DRAKE DR
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-3907
Mailing Address - Country:US
Mailing Address - Phone:937-269-9660
Mailing Address - Fax:
Practice Address - Street 1:1629 DRAKE DR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-3907
Practice Address - Country:US
Practice Address - Phone:937-269-9660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula