Basic Information
Provider Information | |||||||||
NPI: | 1912119777 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WIELER | ||||||||
FirstName: | KRISTEN | ||||||||
MiddleName: | MCLENDON | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | RN, WHNP, CNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MCLENDON | ||||||||
OtherFirstName: | JENNIFER | ||||||||
OtherMiddleName: | KRISTEN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 6285 BARFIELD RD NE | ||||||||
Address2: | SUITE 250 | ||||||||
City: | ATLANTA | ||||||||
State: | GA | ||||||||
PostalCode: | 303284303 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4043031224 | ||||||||
FaxNumber: | 4043031325 | ||||||||
Practice Location | |||||||||
Address1: | 4488 N SHALLOWFORD RD | ||||||||
Address2: | SUITE 210 | ||||||||
City: | ATLANTA | ||||||||
State: | GA | ||||||||
PostalCode: | 303386413 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7707300451 | ||||||||
FaxNumber: | 7707300141 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/04/2007 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WW0101X | RN129437 NP | GA | Y |   | Nursing Service Providers | Registered Nurse | Women's Health Care, Ambulatory |
No ID Information.