Provider Demographics
NPI:1720228745
Name:KISTNER, KARLA JEAN (MS, CCC-A)
Entity Type:Individual
Prefix:MISS
First Name:KARLA
Middle Name:JEAN
Last Name:KISTNER
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 S SINGLEY DR
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-3516
Mailing Address - Country:US
Mailing Address - Phone:678-972-9051
Mailing Address - Fax:
Practice Address - Street 1:681 S 9TH ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4215
Practice Address - Country:US
Practice Address - Phone:770-228-5745
Practice Address - Fax:770-228-5317
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003570237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter