Provider Demographics
NPI:1790671931
Name:KRISTY, KAITLYN GRACE
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:GRACE
Last Name:KRISTY
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 1:9900 LANI LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-1661
Mailing Address - Country:US
Mailing Address - Phone:865-368-3030
Mailing Address - Fax:
Practice Address - Street 1:9900 LANI LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-1661
Practice Address - Country:US
Practice Address - Phone:865-368-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program