Provider Demographics
NPI:1689240160
Name:EASTERWOOD, KRISTIE LACHELLE (LPN)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:LACHELLE
Last Name:EASTERWOOD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KRISTIE
Other - Middle Name:LACHELLE
Other - Last Name:GHOLSTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:256 LIME CREEK LN
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:AL
Mailing Address - Zip Code:35043-5596
Mailing Address - Country:US
Mailing Address - Phone:256-404-9884
Mailing Address - Fax:
Practice Address - Street 1:256 LIME CREEK LN
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:AL
Practice Address - Zip Code:35043-5596
Practice Address - Country:US
Practice Address - Phone:256-404-9884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-057384164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty