Provider Demographics
NPI:1164181756
Name:MARTINEZ, KRISTINA ANN
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ANN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:ANN
Other - Last Name:SIPES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:213 ROBERT ALAN DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-0056
Mailing Address - Country:US
Mailing Address - Phone:910-616-6981
Mailing Address - Fax:
Practice Address - Street 1:213 ROBERT ALAN DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-0056
Practice Address - Country:US
Practice Address - Phone:910-616-6981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-11
Last Update Date:2021-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician