Provider Demographics
NPI:1396359279
Name:TOMBLIN, KRISTEN NICOLE
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:NICOLE
Last Name:TOMBLIN
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 1:85 SPARKS DR
Mailing Address - Street 2:
Mailing Address - City:DINGESS
Mailing Address - State:WV
Mailing Address - Zip Code:25671-1105
Mailing Address - Country:US
Mailing Address - Phone:304-752-5922
Mailing Address - Fax:
Practice Address - Street 1:85 SPARKS DR
Practice Address - Street 2:
Practice Address - City:DINGESS
Practice Address - State:WV
Practice Address - Zip Code:25671-1105
Practice Address - Country:US
Practice Address - Phone:304-752-5922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant