Provider Demographics
NPI:1548959034
Name:CLIFTON, KRISTIN (FNP-BC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:CLIFTON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 MEADOWS LN # 2
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-9905
Mailing Address - Country:US
Mailing Address - Phone:912-278-7990
Mailing Address - Fax:
Practice Address - Street 1:1608 MEADOWS LN # 2
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-9905
Practice Address - Country:US
Practice Address - Phone:912-537-9488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA274423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily