Provider Demographics
NPI:1598567877
Name:HEUERMAN, KRISTEN ROACH (APRN, CNM)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ROACH
Last Name:HEUERMAN
Suffix:
Gender:
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:MEGAN
Other - Last Name:ROACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1942 ATKINSON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5004
Mailing Address - Country:US
Mailing Address - Phone:678-775-0600
Mailing Address - Fax:678-377-5284
Practice Address - Street 1:1942 ATKINSON RD STE 100
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5004
Practice Address - Country:US
Practice Address - Phone:678-775-0600
Practice Address - Fax:678-377-5284
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN302045367A00000X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife