Provider Demographics
NPI:1881393692
Name:AUBUCHON, KRISTIE LYNN JONES (LMT)
Entity type:Individual
Prefix:
First Name:KRISTIE LYNN
Middle Name:JONES
Last Name:AUBUCHON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5006 LARKEN CT
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-9317
Mailing Address - Country:US
Mailing Address - Phone:865-299-0758
Mailing Address - Fax:
Practice Address - Street 1:5006 LARKEN CT
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-9317
Practice Address - Country:US
Practice Address - Phone:865-299-0758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12936225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist