Provider Demographics
NPI:1578792933
Name:WICK, KRISTINA CARLTON (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:CARLTON
Last Name:WICK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 GUNBARREL RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3291
Mailing Address - Country:US
Mailing Address - Phone:423-899-2904
Mailing Address - Fax:423-892-5058
Practice Address - Street 1:1651 GUNBARREL RD
Practice Address - Street 2:SUITE 302
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3291
Practice Address - Country:US
Practice Address - Phone:423-899-2904
Practice Address - Fax:423-892-5058
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13952363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily