Provider Demographics
NPI:1205695145
Name:CORNELIUS, KRISTEN ELIZABETH (MSN, AG-ACNP, CV-BC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ELIZABETH
Last Name:CORNELIUS
Suffix:
Gender:
Credentials:MSN, AG-ACNP, CV-BC
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:ELIZABETH
Other - Last Name:WATERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3970 DEP BILL CANTRELL MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-3011
Mailing Address - Country:US
Mailing Address - Phone:678-513-2273
Mailing Address - Fax:678-513-8869
Practice Address - Street 1:53 GORDON RD STE 102
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-1017
Practice Address - Country:US
Practice Address - Phone:678-513-2273
Practice Address - Fax:678-513-8869
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN278770363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology