Provider Demographics
NPI:1689600231
Name:GRIFFIN, KRISTEN P (APRN-CPNP)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:P
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:APRN-CPNP
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:PINELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 277775
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-7775
Mailing Address - Country:US
Mailing Address - Phone:803-434-7903
Mailing Address - Fax:803-434-8606
Practice Address - Street 1:9 RICHLAND MEDICAL PARK DR
Practice Address - Street 2:SUITE 110
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6859
Practice Address - Country:US
Practice Address - Phone:803-434-7961
Practice Address - Fax:803-434-7981
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN2088363LP0200X
SC3152363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0806Medicaid
SCNP0806Medicaid
SCAA04632389Medicare PIN
Q17792Medicare UPIN