Provider Demographics
NPI:1619297959
Name:SWEENEY, KRISTEN N (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:N
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746652
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6652
Mailing Address - Country:US
Mailing Address - Phone:047-200-5999
Mailing Address - Fax:904-376-4036
Practice Address - Street 1:14534 OLD SAINT AUGUSTINE RD STE 3420
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-2645
Practice Address - Country:US
Practice Address - Phone:904-493-8001
Practice Address - Fax:904-388-0852
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA001212363A00000X
NMPA2014-0042363A00000X
FLPA9109458363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant