Provider Demographics
NPI:1811094378
Name:GALL, KRISTYN (CNS)
Entity type:Individual
Prefix:
First Name:KRISTYN
Middle Name:
Last Name:GALL
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 COXE AVE UNIT 303
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4031
Mailing Address - Country:US
Mailing Address - Phone:248-819-8880
Mailing Address - Fax:248-569-9410
Practice Address - Street 1:7001 ORCHARD LAKE RD STE 330
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3607
Practice Address - Country:US
Practice Address - Phone:248-862-2995
Practice Address - Fax:248-862-2814
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704201577364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4374223Medicaid
MIN83430004Medicare ID - Type Unspecified
MI4374223Medicaid