Provider Demographics
NPI:1801187927
Name:CONNER, KRISTEN BLYTHE (LAC, CMT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:BLYTHE
Last Name:CONNER
Suffix:
Gender:F
Credentials:LAC, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 KAINS AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1271
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:405 KAINS AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1271
Practice Address - Country:US
Practice Address - Phone:510-558-8062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-23
Last Update Date:2011-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13617171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist