Provider Demographics
NPI:1558614487
Name:LEY, KRISTIN CARTER (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:CARTER
Last Name:LEY
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:CULLARS
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1199 PRINCE AVE
Mailing Address - Street 2:MEDICAL SERVICES BUILDING, SECOND FLOOR
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2797
Mailing Address - Country:US
Mailing Address - Phone:706-475-1950
Mailing Address - Fax:
Practice Address - Street 1:1199 PRINCE AVE
Practice Address - Street 2:MEDICAL SERVICES BUILDING, SECOND FLOOR
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2797
Practice Address - Country:US
Practice Address - Phone:706-475-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN201110363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care