Provider Demographics
NPI:1508160102
Name:BRANSTETTER, CRISTYN NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:CRISTYN
Middle Name:NICOLE
Last Name:BRANSTETTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CRISTYN
Other - Middle Name:NICOLE
Other - Last Name:CAMET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 CHILDRENS WAY # 844
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3500
Mailing Address - Country:US
Mailing Address - Phone:501-364-2090
Mailing Address - Fax:501-364-3929
Practice Address - Street 1:2601 GENE GEORGE BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762
Practice Address - Country:US
Practice Address - Phone:479-725-6801
Practice Address - Fax:479-725-6577
Is Sole Proprietor?:No
Enumeration Date:2010-12-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10030749208000000X
TXN88932080P0207X
ARE-11200208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR205930001Medicaid