1912119777 NPI number — KRISTEN MCLENDON WIELER RN, WHNP, CNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912119777 NPI number — KRISTEN MCLENDON WIELER RN, WHNP, CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WIELER
Provider First Name:
KRISTEN
Provider Middle Name:
MCLENDON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, WHNP, CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCLENDON
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
KRISTEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912119777
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6285 BARFIELD RD NE
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30328-4303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-303-1224
Provider Business Mailing Address Fax Number:
404-303-1325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4488 N SHALLOWFORD RD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30338-6413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-730-0451
Provider Business Practice Location Address Fax Number:
770-730-0141
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WW0101X , with the licence number:  RN129437 NP , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com