Provider Demographics
NPI:1164081303
Name:KIMBLER, KRISTI (NP)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:KIMBLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:NICOLE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2326 HIGHWAY 34 E
Mailing Address - Street 2:STE 201
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1328
Mailing Address - Country:US
Mailing Address - Phone:678-664-1545
Mailing Address - Fax:
Practice Address - Street 1:2326 HIGHWAY 34 E STE 201
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1328
Practice Address - Country:US
Practice Address - Phone:678-664-1545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN183846363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care