Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | E-6205 | AR |
N | 207Q00000X | Family Doctor | E-6205 | AR |
Y | 207QA0401X | Family Doctor - Addiction Medicine | E-6205 | AR |
NPI | 1689835225 |
---|---|
Provider Name | Dr. Kristin Kay Martin |
First Address | Pine Bluff, AR 71603-7322 |
Second Address | Russellville, AR 72802-2206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2008 |
Last Update Date | 24/06/2021 |