MEDICARE: KRISTIN WARD WARREN 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
1	363A00000X	Physician Assistant	0010-00270	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	212562	OTHER	NC	MEDCOST

General Provider Information

NPI Number	:	1942376322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN WARD WARREN PA-C

Provider Business Mailing Address
First Line	:	7100 COMMERCE WAY
Second Line	:	SUITE 180
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-2829
Country	:	US
Telephone Number	:	615-465-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 GREEN ST
Second Line	:
City	:	WILLIAMSTON
State	:	NC
Zip	:	27892-2000
Country	:	US
Telephone Number	:	252-792-0305
Fax Number	:	252-792-0307

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	08/08/2008

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