Provider Demographics
NPI:1750834198
Name:DELUNA, KRISTEN DANIELLE (NP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:DANIELLE
Last Name:DELUNA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:DANIELLE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:840 W FLOYD BAKER BLVD
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-1845
Practice Address - Country:US
Practice Address - Phone:864-489-3300
Practice Address - Fax:864-488-3744
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC109610163WE0003X
SC20344363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP4073Medicaid
SCSC91455019OtherMEDICARE PIN
SCSC9145J577OtherMEDICARE PIN
SCSC91456121OtherMEDICARE PIN
SCSC91456084OtherMEDICARE PIN
SCSC91456067OtherMEDICARE PIN