Individual
KAITLIN DIVINNIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGPCNP
Contact information
Practice address
1365 CLIFTON RD NE BLDG B, ATLANTA, GA 30322-3736
(404) 778-3184
Mailing address
3518 PRESERVE DR SE, ATLANTA, GA 30339-3736
(615) 973-0905
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
RN224677
GA
363LP2300X
Primary Care Nurse Practitioner
Primary
RN224677
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174997647
—
GA
Enumeration date
11/21/2015
Last updated
07/21/2022
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