MEDICARE: KRISTINA G. ALDRICH NP-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
1	363L00000X	Nurse Practitioner	25243	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G25243	OTHER	SC	SC BOARD OF NURSING PRESCRIPTIVE AUTHORITY
2	25243	OTHER	SC	SC BOARD OF NURSING

General Provider Information

NPI Number	:	1770191652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA G. ALDRICH NP-C

Provider Business Mailing Address
First Line	:	206 RIESLING WAY
Second Line	:
City	:	MAULDIN
State	:	SC
Zip	:	29662-2855
Country	:	US
Telephone Number	:	864-363-8438
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 ROPER MOUNTAIN RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4228
Country	:	US
Telephone Number	:	864-770-0890
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2020
Last Update Date	:	08/25/2021

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