Provider Demographics
NPI:1578044731
Name:DEWBERRY, KRISTIAN FAITH
Entity type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:FAITH
Last Name:DEWBERRY
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 1:245 COUNTY ROAD 124
Mailing Address - Street 2:
Mailing Address - City:BRUNDIDGE
Mailing Address - State:AL
Mailing Address - Zip Code:36010-5308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:245 COUNTY ROAD 124
Practice Address - Street 2:
Practice Address - City:BRUNDIDGE
Practice Address - State:AL
Practice Address - Zip Code:36010-5308
Practice Address - Country:US
Practice Address - Phone:334-482-3667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program