Basic Information
| Provider Information | |||||||||
| NPI: | 1417187170 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RANZENBERGER | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 950248 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402950248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024895730 | ||||||||
| FaxNumber: | 5024895753 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 LONG SHOALS RD STE 110 | ||||||||
| Address2: | |||||||||
| City: | ARDEN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287048794 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282134444 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2009 | ||||||||
| LastUpdateDate: | 04/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083X0100X | 03850 | KY | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine | 208D00000X | 49490 | CO | N | Allopathic & Osteopathic Physicians | General Practice | 2083X0100X | 2008-00010 | NC | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2083X0100X | 01 | KY | TAXONOMY | OTHER | 1417187170 | 05 | NC | MEDICAID |