Provider Demographics
NPI:1790710168
Name:RAGER, KRISTIN MICHELE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MICHELE
Last Name:RAGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31609
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-0169
Mailing Address - Country:US
Mailing Address - Phone:615-499-7406
Mailing Address - Fax:833-968-2944
Practice Address - Street 1:442 METROPLEX DR STE 200
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-3112
Practice Address - Country:US
Practice Address - Phone:615-499-7406
Practice Address - Fax:833-968-2944
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-015292080A0000X
TNMD468312080A0000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1522616Medicaid
KY64082498Medicaid
KY64082498Medicaid
TN1522616Medicaid