Provider Demographics
NPI:1265865653
Name:IRELAND, KRISTIN M (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:IRELAND
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3735 GLENLAKE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-6846
Mailing Address - Country:US
Mailing Address - Phone:047-749-5800
Mailing Address - Fax:
Practice Address - Street 1:3735 GLENLAKE DR STE 250
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-6866
Practice Address - Country:US
Practice Address - Phone:704-749-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007561363L00000X, 363LA2100X
NC275683363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1265865653Medicaid
SCNP3195Medicaid
NCNCN643BMedicare PIN
NCNCN643CMedicare PIN
SCNP3195Medicaid