Provider Demographics
NPI:1518339522
Name:TARBELL, KRYSTEN
Entity Type:Individual
Prefix:
First Name:KRYSTEN
Middle Name:
Last Name:TARBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRYSTEN
Other - Middle Name:
Other - Last Name:TARBELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNA
Mailing Address - Street 1:1021 GLENARDEN DR APT B
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-3585
Mailing Address - Country:US
Mailing Address - Phone:803-389-5040
Mailing Address - Fax:704-357-3405
Practice Address - Street 1:1021 GLENARDEN DR APT B
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-3585
Practice Address - Country:US
Practice Address - Phone:803-389-5040
Practice Address - Fax:704-357-3405
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC550357374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide