Provider Demographics
NPI:1083909170
Name:WARD, KRISTEN NICOLE (DO)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:NICOLE
Last Name:WARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 MANNING DR
Mailing Address - Street 2:EMERGENCY MED.,POB 1ST FL, CB# 7594
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4221
Mailing Address - Country:US
Mailing Address - Phone:919-966-6442
Mailing Address - Fax:919-966-3049
Practice Address - Street 1:170 MANNING DR
Practice Address - Street 2:EMERGENCY MED.,POB 1ST FL, CB# 7594
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4221
Practice Address - Country:US
Practice Address - Phone:919-966-6442
Practice Address - Fax:919-966-3049
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC172774390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program