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General NPI Number Information
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NPI Number | 1871971648
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Entity Type | Individual
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Provider Name | KRISTA MICHELLE POULTON FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/13/2015
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 1268 S 4TH ST
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City | HARTSVILLE
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State | SC
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Zip | 29550-0703
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Country | US
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Telephone | 843-332-3422
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Fax | 842-332-3985
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Provider Business Mailing Address
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Address Line | 1104 WINDSHALL RD
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City | DARLINGTON
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State | SC
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Zip | 29540
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Country | US
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Telephone | 423-612-5300
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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 | 19457
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License Number State | SC
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