Provider Demographics
NPI:1265805196
Name:RARDIN, KRISTEN DAVIS (CNM)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:DAVIS
Last Name:RARDIN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2388 CLARK AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-1058
Mailing Address - Country:US
Mailing Address - Phone:214-790-2309
Mailing Address - Fax:
Practice Address - Street 1:2388 CLARK AVE UNIT B
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-1058
Practice Address - Country:US
Practice Address - Phone:214-790-2309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11025273367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife