Provider Demographics
NPI:1104298371
Name:HANAFORD, KATY (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KATY
Middle Name:
Last Name:HANAFORD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 WINDERMERE PKWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3850 WINDERMERE PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7002
Practice Address - Country:US
Practice Address - Phone:678-455-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA143296163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse