MEDICARE: KRISTIN WHITELY GAINES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	2018-00973	NC
2	207R00000X	Internal Medicine Physician	2018-00973	NC

General Provider Information

NPI Number	:	1679991657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN WHITELY GAINES MD

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	844-266-8268
Fax Number	:

Provider Business Practice Location Address
First Line	:	9615 KINCEY AVE STE 100
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-9140
Country	:	US
Telephone Number	:	704-316-5635
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2014
Last Update Date	:	04/29/2021

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