Basic Information
| Provider Information | |||||||||
| NPI: | 1659787646 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RHOADES | ||||||||
| FirstName: | KIERSTEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1305 CENTRAL AVE APT 352 | ||||||||
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| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282055193 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7169844367 | ||||||||
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| Practice Location | |||||||||
| Address1: | 920 CHURCH ST N | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280252927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044033000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2014 | ||||||||
| LastUpdateDate: | 01/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 209.011618 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.