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General NPI Number Information
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NPI Number | 1891267290
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Entity Type | Individual
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Provider Name | KRISTEN RUSSELL APRN
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Gender | Female
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Dates
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Enumeration Date | 12/23/2018
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 100 EAST WOOD ST SUITE 100
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City | SPARTANBURG
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State | SC
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Zip | 29303
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Country | US
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Telephone | 864-583-1222
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Fax |
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Provider Business Mailing Address
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Address Line | 100 E WOOD ST STE 100
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City | SPARTANBURG
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State | SC
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Zip | 29303-3001
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Country | US
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Telephone | 864-583-1222
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3012945
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RXF27267
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3012945
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License Number State | KY
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