Provider Demographics
NPI:1972993137
Name:JANKIEWICZ, KATHRON MAE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHRON
Middle Name:MAE
Last Name:JANKIEWICZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-8385
Mailing Address - Country:US
Mailing Address - Phone:678-619-1974
Mailing Address - Fax:678-619-1975
Practice Address - Street 1:480 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-8385
Practice Address - Country:US
Practice Address - Phone:678-619-1974
Practice Address - Fax:678-619-1975
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN216253363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily