Provider Demographics
NPI:1427467505
Name:GOWEN, KRISTY LEIGH (APRN)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:LEIGH
Last Name:GOWEN
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:288 PLANTATION PT
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:GA
Mailing Address - Zip Code:31569-2115
Mailing Address - Country:US
Mailing Address - Phone:912-467-3412
Mailing Address - Fax:
Practice Address - Street 1:3435 SECOND ST S
Practice Address - Street 2:
Practice Address - City:FOLKSTON
Practice Address - State:GA
Practice Address - Zip Code:31537-8447
Practice Address - Country:US
Practice Address - Phone:912-467-0041
Practice Address - Fax:912-496-0053
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN231693363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner