Provider Demographics
NPI:1972564102
Name:JOHNSON, KIRSTEN NATIONS (CPNP)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:NATIONS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 COLLINS DR STE B
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-8533
Mailing Address - Country:US
Mailing Address - Phone:770-607-0795
Mailing Address - Fax:770-607-1339
Practice Address - Street 1:20 COLLINS DR STE B
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-8533
Practice Address - Country:US
Practice Address - Phone:770-607-0795
Practice Address - Fax:770-607-1339
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO172752363LP0200X
GARN139381363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA336125OtherWELLCARE ID NUMBER
GA000861627COtherPEACH STATE ID
GA5261615OtherCIGNA
GA598970OtherBCBS
GA000861627CMedicaid
GA049906810OtherCHAMPUS TRICARE
GA10057735OtherAMERIGROUP