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NPI Code Detail

MEDICARE: DR. KRISTEN LYNN NEUHARTH MD

MEDICARE: DR. KRISTEN LYNN NEUHARTH MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianME115092FL
2208M00000XHospitalist PhysicianME115092FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P01234878OTHERFLRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033195573
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRISTEN LYNN NEUHARTH MD
Provider Business Mailing Address
First Line : PO BOX 746638
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6638
Country : US
Telephone Number : 904-202-1032
Fax Number : 904-376-4107
Provider Business Practice Location Address
First Line : 820 PRUDENTIAL DR STE 304
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8205
Country : US
Telephone Number : 904-202-3860
Fax Number : 904-202-3846
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2005
Last Update Date : 11/26/2024

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