Provider Demographics
NPI:1346885381
Name:KREISMANIS, DIANA LYNN (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:KREISMANIS
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 JACKSON AVE
Mailing Address - Street 2:STE A
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-3481
Mailing Address - Country:US
Mailing Address - Phone:706-647-8101
Mailing Address - Fax:706-647-8543
Practice Address - Street 1:107 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3481
Practice Address - Country:US
Practice Address - Phone:678-544-1107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN245695363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF10190682OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS