Provider Demographics
NPI:1144344359
Name:MUMFORD, KRISTEN MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:MARIE
Last Name:MUMFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTEN
Other - Middle Name:MARIE
Other - Last Name:WHELIHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1925 W PARK DR
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-3564
Mailing Address - Country:US
Mailing Address - Phone:336-903-0147
Mailing Address - Fax:336-903-1687
Practice Address - Street 1:1925 W PARK DR
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659
Practice Address - Country:US
Practice Address - Phone:336-903-0147
Practice Address - Fax:336-903-1687
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD441072208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2018-01668OtherSTATE MEDICAL LICENSES