Provider Demographics
NPI:1891966685
Name:DONLAN, KRISTI ANN TUCKER (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:KRISTI ANN
Middle Name:TUCKER
Last Name:DONLAN
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:106 PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-2445
Practice Address - Country:US
Practice Address - Phone:864-797-9100
Practice Address - Fax:864-241-9239
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18255363LP0200X
MI4704277888363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2454Medicaid