Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0004X | Health Psychologist | 2345 | NC |
NPI | 1477702595 |
---|---|
Provider Name | Mrs. Kristan Mull Jenkins |
First Address | Morganton, NC 28655-5197 |
Second Address | Morganton, NC 28655-5197 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2008 |
Last Update Date | 12/09/2008 |