Healthcare Provider Details

I. General information

NPI: 1407225568
Provider Name (Legal Business Name): KRISTI L STOVER RAYMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 GADSDEN HIGHWAY SUITE 100
BIRMINGHAM AL
35235
US

IV. Provider business mailing address

8800 SE SUNNYSIDE RD STE 300N
CLACKAMAS OR
97015-5703
US

V. Phone/Fax

Practice location:
  • Phone: 205-655-5930
  • Fax:
Mailing address:
  • Phone: 281-286-2999
  • Fax: 512-607-4893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2201
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: