Provider Demographics
NPI:1508586017
Name:COLLIER, KRISTEN BROOKE (RN)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:BROOKE
Last Name:COLLIER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 MANORS MILL CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-7244
Mailing Address - Country:US
Mailing Address - Phone:770-324-8752
Mailing Address - Fax:
Practice Address - Street 1:6060 LAKE ACWORTH DR NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-7358
Practice Address - Country:US
Practice Address - Phone:770-575-0679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN265260163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse