Provider Demographics
NPI:1801245824
Name:ERKILETIAN, KRISTIN
Entity type:Individual
Prefix:MISS
First Name:KRISTIN
Middle Name:
Last Name:ERKILETIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3817 CRIBBON AVE
Mailing Address - Street 2:APT. B
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-1083
Mailing Address - Country:US
Mailing Address - Phone:314-229-1170
Mailing Address - Fax:
Practice Address - Street 1:3817 CRIBBON AVE
Practice Address - Street 2:APT. B
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-1083
Practice Address - Country:US
Practice Address - Phone:314-229-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY109457-663171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator