Provider Demographics
NPI:1144983602
Name:MAYO, KRISTIANNA KATHERINE (NP)
Entity type:Individual
Prefix:
First Name:KRISTIANNA
Middle Name:KATHERINE
Last Name:MAYO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9920 KINCEY AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-2401
Mailing Address - Country:US
Mailing Address - Phone:704-820-4197
Mailing Address - Fax:704-285-8160
Practice Address - Street 1:9920 KINCEY AVE STE 140
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-2401
Practice Address - Country:US
Practice Address - Phone:704-820-4197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5015246363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner