Individual
KRISTEN GRACE VAN WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
111 MOUNTAIN BROOK DR, CANTON, GA 30115-9045
(678) 880-9654
Mailing address
3760 STATION DR NW, KENNESAW, GA 30144-2141
(812) 821-3882
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN266451
GA
Other
Enumeration date
05/29/2025
Last updated
05/29/2025
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