Healthcare Provider Details

I. General information

NPI: 1790032084
Provider Name (Legal Business Name): KRISTIN ELISABETH FLEMING D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 08/01/2023
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18TH MEDICAL GROUP, UNIT 5142
APO AP
96368-5142
US

IV. Provider business mailing address

PSC 80 BOX 15682
APO AP
96367-0059
US

V. Phone/Fax

Practice location:
  • Phone: 315-630-3618
  • Fax:
Mailing address:
  • Phone: 267-441-7820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number02003993A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number02003993A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: