Provider Demographics
NPI:1477930261
Name:JETT, KRISTEN HEBERT (APRN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:HEBERT
Last Name:JETT
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:NICOLE
Other - Last Name:HEBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:89 SIMONS ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-3715
Mailing Address - Country:US
Mailing Address - Phone:832-205-4386
Mailing Address - Fax:
Practice Address - Street 1:2713 DANTZLER DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9005
Practice Address - Country:US
Practice Address - Phone:843-764-1722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19430363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily