Provider Demographics
NPI:1447813373
Name:HAMMOND, KRISTEN NICOLE (PA)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:NICOLE
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:NICOLE
Other - Last Name:HAMMOND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:1605 VERNON RD STE 1500
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4166
Mailing Address - Country:US
Mailing Address - Phone:706-884-1712
Mailing Address - Fax:706-223-1934
Practice Address - Street 1:1605 VERNON RD STE 1500
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4166
Practice Address - Country:US
Practice Address - Phone:706-884-1712
Practice Address - Fax:706-223-1934
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000003755363A00000X
GA9192363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant