Provider Demographics
NPI:1376931824
Name:TRIBBLE, KRISTAL TURNER (NP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTAL
Middle Name:TURNER
Last Name:TRIBBLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 PLAZA CIR STE N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-7556
Mailing Address - Country:US
Mailing Address - Phone:864-547-2160
Mailing Address - Fax:
Practice Address - Street 1:700 PLAZA CIR STE N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-7556
Practice Address - Country:US
Practice Address - Phone:864-547-2160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC210322163W00000X
SC25514363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP7969Medicaid