Provider Demographics
NPI:1770342636
Name:TURENTINE, KRYSTEN
Entity type:Individual
Prefix:
First Name:KRYSTEN
Middle Name:
Last Name:TURENTINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6628 E 45TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-3627
Mailing Address - Country:US
Mailing Address - Phone:317-540-0123
Mailing Address - Fax:
Practice Address - Street 1:6628 E 45TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-3627
Practice Address - Country:US
Practice Address - Phone:317-540-0123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor