Provider Demographics
NPI:1003683095
Name:ALEGRE, MARY KRISTINE (FNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KRISTINE
Last Name:ALEGRE
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4244 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3087
Mailing Address - Country:US
Mailing Address - Phone:706-760-7607
Mailing Address - Fax:
Practice Address - Street 1:4244 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3087
Practice Address - Country:US
Practice Address - Phone:706-760-7607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-08
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY353196363LF0000X
GANP002505363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily