Healthcare Provider Details

I. General information

NPI: 1790935765
Provider Name (Legal Business Name): CHRISTINE M KENT AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 LATROBE AVE
ST AUGUSTINE FL
32095-8613
US

IV. Provider business mailing address

153 LATROBE AVE
ST AUGUSTINE FL
32095-8613
US

V. Phone/Fax

Practice location:
  • Phone: 631-241-0215
  • Fax:
Mailing address:
  • Phone: 631-241-0215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number0022041
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAY2638
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: