Provider Demographics
NPI:1275993149
Name:DOUGAN, KRISTI (NP-C)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:DOUGAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9723 NORTHEAST PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-9719
Mailing Address - Country:US
Mailing Address - Phone:980-262-3007
Mailing Address - Fax:980-262-3528
Practice Address - Street 1:9723 NORTHEAST PKWY STE 100
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-9719
Practice Address - Country:US
Practice Address - Phone:980-262-3007
Practice Address - Fax:980-262-3528
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008420363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1275993149Medicaid