Provider Demographics
NPI:1821678780
Name:CAPOVILLA, KRISTEN MARIE (WHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:MARIE
Last Name:CAPOVILLA
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 TOWNE LAKE PKWY STE 404
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-1604
Mailing Address - Country:US
Mailing Address - Phone:770-926-9229
Mailing Address - Fax:706-946-5074
Practice Address - Street 1:900 TOWNE LAKE PKWY STE 404
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-1604
Practice Address - Country:US
Practice Address - Phone:770-926-9229
Practice Address - Fax:706-946-5074
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN246089363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty