Provider Demographics
NPI:1306620265
Name:BAUCOM, KIERSTIN
Entity type:Individual
Prefix:
First Name:KIERSTIN
Middle Name:
Last Name:BAUCOM
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:WAKE FOREST UNIVERSITY SCHOOL OF MEDICINE NURSE ANESTHE
Mailing Address - Street 2:525 VINE ST
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101
Mailing Address - Country:US
Mailing Address - Phone:336-716-1411
Mailing Address - Fax:
Practice Address - Street 1:WAKE FOREST UNIVERSITY SCHOOL OF MEDICINE NURSE ANESTHE
Practice Address - Street 2:525 VINE ST
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101
Practice Address - Country:US
Practice Address - Phone:336-716-1411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program