Healthcare Provider Details
I. General information
NPI: 1932308533
Provider Name (Legal Business Name): KRISTIN LYNN CANTERBURY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 07/13/2007
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2600 MIDDLETOWN CMNS STE 130
WHITE HALL WV
26554-1068
US
IV. Provider business mailing address
2600 MIDDLETOWN CMNS STE 130
WHITE HALL WV
26554-1068
US
V. Phone/Fax
- Phone: 833-351-8255
- Fax:
- Phone: 803-608-9300
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | 345861 |
| License Number State | NY |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | 26117 |
| License Number State | WV |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | 113834 |
| License Number State | GA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: