Healthcare Provider Details

I. General information

NPI: 1578726378
Provider Name (Legal Business Name): KRISTIN PATRICIA DIERKS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN PATRICIA BARTON MD

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 E HORTON ST
ZEBULON NC
27597-2820
US

IV. Provider business mailing address

260 HORIZON DR
RALEIGH NC
27615-4922
US

V. Phone/Fax

Practice location:
  • Phone: 919-269-2885
  • Fax: 919-488-1718
Mailing address:
  • Phone: 919-488-0015
  • Fax: 919-277-0066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number2013-02124
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2013-02124
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: