Provider Demographics
NPI:1740967504
Name:TRIPLETT, KISHA NAKEY (CPT)
Entity type:Individual
Prefix:PROF
First Name:KISHA
Middle Name:NAKEY
Last Name:TRIPLETT
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13787 HOLLY ST NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-4162
Mailing Address - Country:US
Mailing Address - Phone:612-859-4472
Mailing Address - Fax:
Practice Address - Street 1:13787 HOLLY ST NW
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-4162
Practice Address - Country:US
Practice Address - Phone:612-859-4472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAX9T7J7Y8246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty