1245470442 NPI number — KRISTIN M MCCARVER CNP

Table of content: (NPI 1821056813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245470442 NPI number — KRISTIN M MCCARVER CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCARVER
Provider First Name:
KRISTIN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245470442
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3495 PIEDMONT CENTER
Provider Second Line Business Mailing Address:
NINE PIEDMONT CENTER
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-364-7070
Provider Business Mailing Address Fax Number:
404-686-4696

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 MT. ZION PARKWAY
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE SOUTHWOOD MEDICAL CENTER
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-686-8862
Provider Business Practice Location Address Fax Number:
404-686-4696
Provider Enumeration Date:
02/27/2009

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: 363LF0000X , with the licence number:  RN142303 , 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)

  • Identifier: RN142303 . This is a "STATE OF GEORGIA NURSING LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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