Basic Information
| Provider Information | |||||||||
| NPI: | 1508841370 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ECKLAND | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | ACNP, BC, RNFA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1000 DEPT 960 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381480001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017630200 | ||||||||
| FaxNumber: | 9012601704 | ||||||||
| Practice Location | |||||||||
| Address1: | 1325 EASTMORELAND AVE | ||||||||
| Address2: | SUITE 365 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381043519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012726030 | ||||||||
| FaxNumber: | 9015168450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2005 | ||||||||
| LastUpdateDate: | 02/23/2017 | ||||||||
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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 | 363LA2100X | 61944 | WV | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LA2100X | APN0000011834 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LA2100X | 0024167225 | VA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LA2100X | 2005-01389 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LA2100X | PENDING | VI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LA2100X | AP4242 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | 11834 | 01 | TN | ADVANCED PRACTICE NURSE | OTHER | 2005009361-28 | 01 | NATIONAL CERTIFICATION | OTHER | 61944 | 01 | WV | NURSING LICENSE/ ADVANCED | OTHER | PENDING | 01 | VI | NURSING LICENSE | OTHER | 140397 | 01 | TN | RN LICENSE (NP PENDING) | OTHER |