Provider Demographics
NPI:1740049071
Name:POWELL, KRISTAN BUCHANAN
Entity type:Individual
Prefix:MS
First Name:KRISTAN
Middle Name:BUCHANAN
Last Name:POWELL
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 1:405 ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-2501
Mailing Address - Country:US
Mailing Address - Phone:828-443-9905
Mailing Address - Fax:
Practice Address - Street 1:300 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655
Practice Address - Country:US
Practice Address - Phone:828-608-0867
Practice Address - Fax:828-608-0951
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist