Provider Demographics
NPI:1831722081
Name:COULTER, KIRSTY
Entity type:Individual
Prefix:
First Name:KIRSTY
Middle Name:
Last Name:COULTER
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 1:406 UNIT 1020 BABBIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06269-0001
Mailing Address - Country:US
Mailing Address - Phone:775-378-5850
Mailing Address - Fax:
Practice Address - Street 1:406 UNIT 1020 BABBIDGE RD
Practice Address - Street 2:
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06269-0001
Practice Address - Country:US
Practice Address - Phone:775-378-5850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-17
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program