Basic Information
| Provider Information | |||||||||
| NPI: | 1760159545 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEATON | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 864 NEEDMORE RD W | ||||||||
| Address2: | |||||||||
| City: | HALLS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380406950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316123882 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 710 CARL PERKINS PKWY | ||||||||
| Address2: | |||||||||
| City: | TIPTONVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380791678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7312536690 | ||||||||
| FaxNumber: | 7312536692 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2021 | ||||||||
| LastUpdateDate: | 08/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 30202 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.