MEDICARE: MRS. KRIS MARIE MARTIN CSA

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	174400000X	Specialist
2	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1982695607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRIS MARIE MARTIN CSA

Provider Business Mailing Address
First Line	:	7344 CUMBERLAND CIR
Second Line	:
City	:	FLORENCE
State	:	KY
Zip	:	41042-8282
Country	:	US
Telephone Number	:	859-746-1411
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 GLEN ECHO RD STE 111
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2857
Country	:	US
Telephone Number	:	954-791-6146
Fax Number	:

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	11/18/2022

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