Provider Demographics
NPI:1760159545
Name:DEATON, KRISTEN (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:DEATON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:864 NEEDMORE RD W
Mailing Address - Street 2:
Mailing Address - City:HALLS
Mailing Address - State:TN
Mailing Address - Zip Code:38040-6950
Mailing Address - Country:US
Mailing Address - Phone:731-612-3882
Mailing Address - Fax:
Practice Address - Street 1:710 CARL PERKINS PKWY
Practice Address - Street 2:
Practice Address - City:TIPTONVILLE
Practice Address - State:TN
Practice Address - Zip Code:38079-1678
Practice Address - Country:US
Practice Address - Phone:731-253-6690
Practice Address - Fax:731-253-6692
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30202363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health