Provider Demographics
NPI:1679064992
Name:CANTRELL, KRISTIAN MAPLES (MD)
Entity type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:MAPLES
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTIAN
Other - Middle Name:ANNA
Other - Last Name:MAPLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 15004
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37901-5004
Mailing Address - Country:US
Mailing Address - Phone:865-541-8895
Mailing Address - Fax:
Practice Address - Street 1:2018 CLINCH AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2301
Practice Address - Country:US
Practice Address - Phone:865-541-8105
Practice Address - Fax:865-541-8713
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN69142208000000X
OK33925208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ087329Medicaid