Provider Demographics
NPI:1760031017
Name:CALLAGHAN, KRISTIN IMOGENE (CMA)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:IMOGENE
Last Name:CALLAGHAN
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 795
Mailing Address - Street 2:
Mailing Address - City:INMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29349-0795
Mailing Address - Country:US
Mailing Address - Phone:864-285-2466
Mailing Address - Fax:
Practice Address - Street 1:212 JOHNSON HILLS DR
Practice Address - Street 2:
Practice Address - City:INMAN
Practice Address - State:SC
Practice Address - Zip Code:29349-7181
Practice Address - Country:US
Practice Address - Phone:864-285-2466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health