Healthcare Provider Details

I. General information

NPI: 1558860064
Provider Name (Legal Business Name): ANDREA KIRSTEN OWES ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2018
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

673 SECRET GARDEN LN
DACULA GA
30019-1764
US

IV. Provider business mailing address

673 SECRET GARDEN LN
DACULA GA
30019-1764
US

V. Phone/Fax

Practice location:
  • Phone: 470-542-5276
  • Fax:
Mailing address:
  • Phone: 470-542-5276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00944000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF402335
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: