Provider Demographics
NPI:1184698896
Name:PELTON, KRISTIE (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:
Last Name:PELTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTIE
Other - Middle Name:
Other - Last Name:LYNN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5908 LYONS VIEW
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919
Mailing Address - Country:US
Mailing Address - Phone:865-583-8686
Mailing Address - Fax:
Practice Address - Street 1:5908 LYONS VIEW
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919
Practice Address - Country:US
Practice Address - Phone:865-583-8686
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13044207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A97199Medicare UPIN