Provider Demographics
NPI:1689879934
Name:STURDEVANT, KRISTEN MICHAELA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:MICHAELA
Last Name:STURDEVANT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6339 22ND AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-4105
Mailing Address - Country:US
Mailing Address - Phone:503-329-2162
Mailing Address - Fax:503-329-2162
Practice Address - Street 1:6339 22ND AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-4105
Practice Address - Country:US
Practice Address - Phone:503-329-2162
Practice Address - Fax:503-329-2162
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8738103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical