Provider Demographics
NPI:1255446076
Name:PUMPHREY, KRISTEN (OD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:PUMPHREY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 FOREST CIR
Mailing Address - Street 2:UNIT 120
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-1439
Mailing Address - Country:US
Mailing Address - Phone:423-753-7760
Mailing Address - Fax:423-753-7466
Practice Address - Street 1:395 FOREST CIR
Practice Address - Street 2:UNIT 120
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-1439
Practice Address - Country:US
Practice Address - Phone:423-753-7760
Practice Address - Fax:423-753-7466
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2497152W00000X
TN2691152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
103I415162Medicare PIN
6363950001Medicare NSC