Healthcare Provider Details

I. General information

NPI: 1245066109
Provider Name (Legal Business Name): KRISTIN CHIE FLORES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. KRISTIN EASTERLY

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 OAK HILL DR
LEBANON TN
37087-2614
US

IV. Provider business mailing address

212 OAK HILL DR
LEBANON TN
37087-2614
US

V. Phone/Fax

Practice location:
  • Phone: 817-980-3659
  • Fax:
Mailing address:
  • Phone: 817-980-3659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number228574
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: