Provider Demographics
NPI:1083950174
Name:O'BRIEN, KRISTIN MARIE (CPNP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARIE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 SOUTH PIKE WEST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-2664
Mailing Address - Country:US
Mailing Address - Phone:803-774-7337
Mailing Address - Fax:803-774-4629
Practice Address - Street 1:370 SOUTH PIKE WEST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2664
Practice Address - Country:US
Practice Address - Phone:803-774-7337
Practice Address - Fax:803-774-4629
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19019363LP0200X
SC204188163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse