Provider Demographics
NPI:1508379751
Name:FENTON, KRISTIN G (ARNP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:G
Last Name:FENTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-1917
Mailing Address - Country:US
Mailing Address - Phone:850-482-2061
Mailing Address - Fax:850-482-6617
Practice Address - Street 1:1798 GEORGIA ST
Practice Address - Street 2:
Practice Address - City:ALFORD
Practice Address - State:FL
Practice Address - Zip Code:32420-6800
Practice Address - Country:US
Practice Address - Phone:850-526-6727
Practice Address - Fax:850-526-1027
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9213724363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health