Provider Demographics
NPI:1073321691
Name:GEORGE, KRISTEN (FNP-C)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:GEORGE
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KRISTEN BRADLEY
Mailing Address - Street 1:103 STONEBORO RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-5568
Mailing Address - Country:US
Mailing Address - Phone:931-993-2508
Mailing Address - Fax:
Practice Address - Street 1:104 WESTSIDE DR STE 4
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3253
Practice Address - Country:US
Practice Address - Phone:931-993-2508
Practice Address - Fax:877-832-3242
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-28
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38079363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily