Individual
MS. ELAINE D. KISTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
1429 E MARION ST, STE 5, SHELBY, NC 28150-4986
(704) 480-5440
Mailing address
300 PINKNEY ST APT 3, SHELBY, NC 28150-5988
(704) 482-3138
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
770
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046ME
BLUE CROSS & BLUE SHIELD
NC
Enumeration date
03/28/2007
Last updated
07/08/2007
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