Provider Demographics
NPI:1972044915
Name:KINDELL, KRISTI
Entity Type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:
Last Name:KINDELL
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:PO BOX 1198
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-1198
Mailing Address - Country:US
Mailing Address - Phone:912-227-8466
Mailing Address - Fax:
Practice Address - Street 1:130 N WOODVALLEY DR
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6669
Practice Address - Country:US
Practice Address - Phone:912-227-8466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health