Healthcare Provider Details

I. General information

NPI: 1346799376
Provider Name (Legal Business Name): KRISTIN HANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN DONNELLY

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2541 PASS RD SUITE F
BILOXI MS
39531
US

IV. Provider business mailing address

PO BOX 8419
BILOXI MS
39535-8087
US

V. Phone/Fax

Practice location:
  • Phone: 228-388-1002
  • Fax: 228-388-1006
Mailing address:
  • Phone: 228-388-5714
  • Fax: 228-388-0017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5725
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: