Provider Demographics
NPI:1770911570
Name:BANTING, KRISTEN ASHLEY (MSSPED)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ASHLEY
Last Name:BANTING
Suffix:
Gender:F
Credentials:MSSPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2064 ROUTE 22B
Mailing Address - Street 2:
Mailing Address - City:MORRISONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12962-3415
Mailing Address - Country:US
Mailing Address - Phone:518-536-2190
Mailing Address - Fax:
Practice Address - Street 1:2064 ROUTE 22B
Practice Address - Street 2:
Practice Address - City:MORRISONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12962-3415
Practice Address - Country:US
Practice Address - Phone:518-536-2190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist