Provider Demographics
NPI:1770191652
Name:ALDRICH, KRISTINA G (NP-C)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:G
Last Name:ALDRICH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 RIESLING WAY
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-2855
Mailing Address - Country:US
Mailing Address - Phone:864-363-8438
Mailing Address - Fax:
Practice Address - Street 1:501 ROPER MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4228
Practice Address - Country:US
Practice Address - Phone:864-770-0890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25243363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG25243OtherSC BOARD OF NURSING PRESCRIPTIVE AUTHORITY
SC25243OtherSC BOARD OF NURSING