Provider Demographics
NPI:1730714189
Name:CRISWELL, SKYE ELIZABETH (NP)
Entity type:Individual
Prefix:
First Name:SKYE
Middle Name:ELIZABETH
Last Name:CRISWELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SKYE
Other - Middle Name:ELIZABETH
Other - Last Name:CRISWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:2701 N DECATUR RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5918
Mailing Address - Country:US
Mailing Address - Phone:770-584-1929
Mailing Address - Fax:
Practice Address - Street 1:2001 PEACHTREE RD NE STE 645
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1476
Practice Address - Country:US
Practice Address - Phone:404-605-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN250523163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty