Provider Demographics
NPI:1821123472
Name:RYAN, KRISTA ANN (RN)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:ANN
Last Name:RYAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1093 MEADOW BLUFF TER
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7535
Mailing Address - Country:US
Mailing Address - Phone:678-482-0199
Mailing Address - Fax:
Practice Address - Street 1:1285 UPPER HEMBREE RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1143
Practice Address - Country:US
Practice Address - Phone:770-343-8565
Practice Address - Fax:770-343-8651
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN100616163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse