Provider Demographics
NPI:1548707011
Name:MUSSO, KRISTEN (CRNA)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:MUSSO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 WHITESTONE RDG
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-6421
Mailing Address - Country:US
Mailing Address - Phone:228-860-9488
Mailing Address - Fax:
Practice Address - Street 1:1275 WHITESTONE RDG
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-6421
Practice Address - Country:US
Practice Address - Phone:228-860-9488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09133367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered