Provider Demographics
NPI:1245066109
Name:FLORES, KRISTIN CHIE (NP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:CHIE
Last Name:FLORES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:EASTERLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:212 OAK HILL DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2614
Mailing Address - Country:US
Mailing Address - Phone:817-980-3659
Mailing Address - Fax:
Practice Address - Street 1:212 OAK HILL DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2614
Practice Address - Country:US
Practice Address - Phone:817-980-3659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN228574163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care