Provider Demographics
NPI:1508586017
Name:SMALLWOOD, KRISTEN COLLIER (RN, CPS-AD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:COLLIER
Last Name:SMALLWOOD
Suffix:
Gender:
Credentials:RN, CPS-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 LENA LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-2896
Mailing Address - Country:US
Mailing Address - Phone:770-324-8752
Mailing Address - Fax:
Practice Address - Street 1:38 LENA LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-2896
Practice Address - Country:US
Practice Address - Phone:770-324-8752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA175T00000X
GARN265260163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No175T00000XOther Service ProvidersPeer Specialist