Provider Demographics
NPI:1578754651
Name:RAFFERTY, KIRSTEN (CNMT, ARRT (N))
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:CNMT, ARRT (N)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 STARBUCK DR
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-6781
Mailing Address - Country:US
Mailing Address - Phone:609-458-9856
Mailing Address - Fax:
Practice Address - Street 1:771 STARBUCK DR
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-6781
Practice Address - Country:US
Practice Address - Phone:609-458-9856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC00-86362471N0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine Technology