Provider Demographics
NPI:1215565577
Name:ZIEMINSKI, KRISTEN MCKELLAR
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MCKELLAR
Last Name:ZIEMINSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 PEERLESS XING NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3764
Mailing Address - Country:US
Mailing Address - Phone:423-476-5990
Mailing Address - Fax:423-476-5887
Practice Address - Street 1:16704 HAWFIELD WAY DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6132
Practice Address - Country:US
Practice Address - Phone:704-337-0221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1011691363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106022500Medicaid
FLBKU08OtherFLORIDA BCBS