Provider Demographics
NPI:1790022705
Name:MARTIN, KRISTI WALTERS (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:WALTERS
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:SC
Mailing Address - Zip Code:29670-9482
Mailing Address - Country:US
Mailing Address - Phone:864-403-2400
Mailing Address - Fax:864-716-3654
Practice Address - Street 1:2850 LEBANON RD
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:SC
Practice Address - Zip Code:29670-9482
Practice Address - Country:US
Practice Address - Phone:864-403-2400
Practice Address - Fax:864-716-3654
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC62308163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool