Provider Demographics
NPI:1174225098
Name:COLE, KRISTEN (APRN)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 THATCHER XING
Mailing Address - Street 2:
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710-7877
Mailing Address - Country:US
Mailing Address - Phone:803-902-1325
Mailing Address - Fax:843-790-1883
Practice Address - Street 1:1570 THATCHER XING
Practice Address - Street 2:
Practice Address - City:CLOVER
Practice Address - State:SC
Practice Address - Zip Code:29710-7877
Practice Address - Country:US
Practice Address - Phone:803-902-1325
Practice Address - Fax:843-790-1883
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2025-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019459363LP0808X
SC27077363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health