Provider Demographics
NPI:1629395041
Name:GARCIA, KRISTEN (BSN, MSN, CPNP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:BSN, MSN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-1210
Mailing Address - Country:US
Mailing Address - Phone:770-304-4215
Mailing Address - Fax:
Practice Address - Street 1:745 POPLAR ROAD
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265
Practice Address - Country:US
Practice Address - Phone:770-400-3201
Practice Address - Fax:770-304-7212
Is Sole Proprietor?:No
Enumeration Date:2010-04-25
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN106401363LN0000X, 363LN0005X
GARN106401NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003106489BMedicaid
GA01603672OtherAMERIGROUP
GA003106489BMedicaid