Provider Demographics
NPI:1134435449
Name:SU, KRISTY MARIE (FNP)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:MARIE
Last Name:SU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:106 RIDGE VIEW DR STE A
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6647
Mailing Address - Country:US
Mailing Address - Phone:919-319-6363
Mailing Address - Fax:919-319-1331
Practice Address - Street 1:106 RIDGE VIEW DR STE A
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6647
Practice Address - Country:US
Practice Address - Phone:919-319-6363
Practice Address - Fax:919-319-1331
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004851363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily