Provider Demographics
NPI:1114388378
Name:OLIVER, KRISTIN (FNP-C)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 CHURCH ST NE
Mailing Address - Street 2:SUITE 550
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7282
Mailing Address - Country:US
Mailing Address - Phone:770-419-9902
Mailing Address - Fax:770-419-7457
Practice Address - Street 1:18 RIVERBEND DR SW
Practice Address - Street 2:SUITE 100
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-6013
Practice Address - Country:US
Practice Address - Phone:706-314-1900
Practice Address - Fax:706-314-1901
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN214105363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner