Provider Demographics
NPI:1255759304
Name:MEREDICK, KRISTIN (MD/MBA)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:
Last Name:MEREDICK
Suffix:
Gender:F
Credentials:MD/MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 PIONEER LN STE H
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-2563
Mailing Address - Country:US
Mailing Address - Phone:760-873-6373
Mailing Address - Fax:
Practice Address - Street 1:153 PIONEER LN STE B
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-2517
Practice Address - Country:US
Practice Address - Phone:630-842-3441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD460271208000000X
CAA149955208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics