Provider Demographics
NPI:1972341550
Name:DANIELS, KIRSTEN LAINE (NP)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:LAINE
Last Name:DANIELS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:240 E BELLE ISLE RD APT 603
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2397
Mailing Address - Country:US
Mailing Address - Phone:804-840-4411
Mailing Address - Fax:
Practice Address - Street 1:6131 S NORCROSS TUCKER RD UNIT 6
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-5536
Practice Address - Country:US
Practice Address - Phone:470-766-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN323167363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner