Provider Demographics
NPI:1942994983
Name:CREEL, MARTHA KRISTEN (RN)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:KRISTEN
Last Name:CREEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-8529
Mailing Address - Country:US
Mailing Address - Phone:601-594-0343
Mailing Address - Fax:
Practice Address - Street 1:911 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-8529
Practice Address - Country:US
Practice Address - Phone:601-594-0343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS877425163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse