Provider Demographics
NPI:1346737582
Name:IVORY, CRISTA JONTE' (NP)
Entity Type:Individual
Prefix:MRS
First Name:CRISTA
Middle Name:JONTE'
Last Name:IVORY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 JEFFERSON PKWY APT G
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-5855
Mailing Address - Country:US
Mailing Address - Phone:270-853-3516
Mailing Address - Fax:
Practice Address - Street 1:772 GREISON TRL STE H
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1498
Practice Address - Country:US
Practice Address - Phone:678-423-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN270057363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily