Provider Demographics
NPI:1760028393
Name:ALLRED, KRISTINA DIANE (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:DIANE
Last Name:ALLRED
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 BIRCHBARK CT
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29672-0784
Mailing Address - Country:US
Mailing Address - Phone:864-888-3235
Mailing Address - Fax:
Practice Address - Street 1:3613 SC-153
Practice Address - Street 2:
Practice Address - City:POWDERSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611
Practice Address - Country:US
Practice Address - Phone:864-207-4257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant