Healthcare Provider Details

I. General information

NPI: 1760937817
Provider Name (Legal Business Name): KRISTEN ALSTON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

2500 N STATE ST
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-815-4778
  • Fax: 601-984-5420
Mailing address:
  • Phone: 601-815-1066
  • Fax: 601-984-6835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number56994
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number56994
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number56994
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: