Healthcare Provider Details

I. General information

NPI: 1376320853
Provider Name (Legal Business Name): KRISTIN MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/11/2023
Certification Date: 09/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 PORTER RD STE 200
NASHVILLE TN
37206-1676
US

IV. Provider business mailing address

808 SKYLINE RIDGE DR APT 312
MADISON TN
37115-1011
US

V. Phone/Fax

Practice location:
  • Phone: 615-572-4424
  • Fax:
Mailing address:
  • Phone: 615-200-5882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: