Provider Demographics
NPI:1891185203
Name:HARPER, KRISTINA (CPM, LM)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:
Last Name:HARPER
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9086 PIGEON ROOST RD STE C
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-1627
Mailing Address - Country:US
Mailing Address - Phone:662-812-6115
Mailing Address - Fax:662-532-5289
Practice Address - Street 1:9086 PIGEON ROOST RD STE C
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654
Practice Address - Country:US
Practice Address - Phone:662-812-6115
Practice Address - Fax:662-532-5289
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN176B00000X
374J00000X
TN67176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula