Provider Demographics
NPI:1356996748
Name:LIKES, KATRINA NICOLE (FNP-C)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:NICOLE
Last Name:LIKES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3995 JEFFERSON TOWNSHIP PKWY
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-1703
Mailing Address - Country:US
Mailing Address - Phone:815-566-1007
Mailing Address - Fax:
Practice Address - Street 1:2965 JOHNSON FERRY RD STE D
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-8364
Practice Address - Country:US
Practice Address - Phone:770-998-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-02
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN238385363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner