Provider Demographics
NPI:1942749155
Name:CUNNINGHAM, KRISTIN
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 LANDRETH CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-7580
Mailing Address - Country:US
Mailing Address - Phone:301-648-4202
Mailing Address - Fax:
Practice Address - Street 1:2905 CROUSE LN
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8833
Practice Address - Country:US
Practice Address - Phone:336-538-2494
Practice Address - Fax:336-538-2497
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC266413163W00000X, 363LF0000X
AZ240168363LF0000X
ID64151363LF0000X
IAA160019363LF0000X
FLAPRN11007574363LF0000X
NC5009313363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse