Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN150295 | GA |
NPI | 1003067026 |
---|---|
Provider Name | Mrs. Kristen Anne Lingle |
First Address | Atlanta, GA 30318-1662 |
Second Address | Atlanta, GA 30318-1662 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2008 |
Last Update Date | 08/10/2008 |