Provider Demographics
NPI:1174026553
Name:SHULTIS, KRISTEN ELIZABETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:ELIZABETH
Last Name:SHULTIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PARAGON MILLS RD APT C4
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4023
Mailing Address - Country:US
Mailing Address - Phone:678-232-7927
Mailing Address - Fax:
Practice Address - Street 1:4555 TROUSDALE DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-4513
Practice Address - Country:US
Practice Address - Phone:615-781-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3533103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical