Provider Demographics
NPI:1114418415
Name:ESTEP, KRISTI BARTLETT (EDS)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:BARTLETT
Last Name:ESTEP
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 ROUNDHILL RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT JACKSON
Mailing Address - State:VA
Mailing Address - Zip Code:22842-3035
Mailing Address - Country:US
Mailing Address - Phone:540-246-1024
Mailing Address - Fax:
Practice Address - Street 1:100 MOUNT CLINTON PIKE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22802-2507
Practice Address - Country:US
Practice Address - Phone:540-564-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPPS-570181103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0813000129Medicaid