Provider Demographics
NPI:1548532898
Name:BURKLE, CRISTY Y (CRNA)
Entity type:Individual
Prefix:
First Name:CRISTY
Middle Name:Y
Last Name:BURKLE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CRISTY
Other - Middle Name:Y
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1359 MILSTEAD RD NE
Mailing Address - Street 2:SUITE103
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3865
Mailing Address - Country:US
Mailing Address - Phone:770-712-4616
Mailing Address - Fax:678-256-3897
Practice Address - Street 1:1412 MILSTEAD AVE NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3877
Practice Address - Country:US
Practice Address - Phone:770-388-7745
Practice Address - Fax:770-922-0526
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN183319367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered