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NPI Code Detail

MEDICARE: KRISTIE COLLINS MARTIN PA-C

MEDICARE: KRISTIE COLLINS MARTIN PA-C
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
1363A00000XPhysician Assistant000103914NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2103914OTHERNCNC LICENSE

General Provider Information

NPI Number : 1053396101
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIE COLLINS MARTIN PA-C
Provider Business Mailing Address
First Line : 460 COUNTRY CLUB RD
Second Line :
City : LUMBERTON
State : NC
Zip : 28360-9494
Country : US
Telephone Number : 910-671-3200
Fax Number :
Provider Business Practice Location Address
First Line : 460 COUNTRY CLUB RD
Second Line :
City : LUMBERTON
State : NC
Zip : 28360-9494
Country : US
Telephone Number : 910-671-3200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2005
Last Update Date : 01/08/2024

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Directions to “ KRISTIE COLLINS MARTIN PA-C” Practice Location

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