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General NPI Number Information
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NPI Number | 1053384073
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Entity Type | Individual
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Provider Name | KRISTIN BRAVEBOY HADDOCK APRN
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Gender | Female
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 03/07/2019
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Provider Practice Location Address
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Address Line | 420 SOCIETY HILL DR STE 100
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City | AIKEN
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State | SC
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Zip | 29803-1731
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Country | US
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Telephone | 803-648-7774
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Fax | 803-648-7490
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Provider Business Mailing Address
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Address Line | 367 S. GULPH RD ATT: IPM CREDENTIALING
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-3121
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Country | US
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Telephone | 803-648-7774
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2601
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License Number State | SC
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