Provider Demographics
NPI:1760610299
Name:CARDENAS, KATHERINE RYAN (RN, MSN, PNP-BC)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:RYAN
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:RN, MSN, PNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 OLD IVY RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4523
Mailing Address - Country:US
Mailing Address - Phone:404-841-5916
Mailing Address - Fax:
Practice Address - Street 1:393 MAXHAM RD STE A&B
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30168-5539
Practice Address - Country:US
Practice Address - Phone:770-732-6007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN187738363LP0200X
CA6586363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics