Provider Demographics
NPI:1982695607
Name:MARTIN, KRIS MARIE (CSA)
Entity Type:Individual
Prefix:MRS
First Name:KRIS
Middle Name:MARIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:MRS
Other - First Name:KRIS
Other - Middle Name:MARIED
Other - Last Name:BEASLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSA
Mailing Address - Street 1:7344 CUMBERLAND CIR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-8282
Mailing Address - Country:US
Mailing Address - Phone:859-746-1411
Mailing Address - Fax:
Practice Address - Street 1:2000 GLEN ECHO RD STE 111
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2857
Practice Address - Country:US
Practice Address - Phone:954-791-6146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No174400000XOther Service ProvidersSpecialist