Provider Demographics
NPI:1932254828
Name:ERDMANN, KRISTAN (ATC, EMT)
Entity type:Individual
Prefix:
First Name:KRISTAN
Middle Name:
Last Name:ERDMANN
Suffix:
Gender:F
Credentials:ATC, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 N CHURCH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:MO
Mailing Address - Zip Code:65248-1123
Mailing Address - Country:US
Mailing Address - Phone:859-398-5398
Mailing Address - Fax:
Practice Address - Street 1:412 N CHURCH ST APT 3
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MO
Practice Address - Zip Code:65248-1123
Practice Address - Country:US
Practice Address - Phone:859-398-5398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY51439146N00000X
KYAT6972255A2300X
MO20190165012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic