Provider Demographics
NPI:1265902134
Name:KRAFT, KYLE BROOKS (AGACNP)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:BROOKS
Last Name:KRAFT
Suffix:
Gender:M
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 PEACHTREE ROAD
Mailing Address - Street 2:DAVIS FISCHER BUILDING, OFFICE 3245A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30088
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 PEACHTREE ROAD
Practice Address - Street 2:DAVIS FISCHER BUILDING, OFFICE 3245A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308
Practice Address - Country:US
Practice Address - Phone:404-686-7858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN235834363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care