Provider Demographics
NPI:1366746539
Name:WALTEMIRE, KRISTY L (BS)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:L
Last Name:WALTEMIRE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-1539
Mailing Address - Country:US
Mailing Address - Phone:814-472-9330
Mailing Address - Fax:814-472-8957
Practice Address - Street 1:118 W HIGH ST
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-1539
Practice Address - Country:US
Practice Address - Phone:814-472-9330
Practice Address - Fax:814-472-8957
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health