Healthcare Provider Details

I. General information

NPI: 1558931188
Provider Name (Legal Business Name): KRISTEN NICOLE VACINEK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2021
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6335 HOSPITAL PKWY STE 304
DULUTH GA
30097-5712
US

IV. Provider business mailing address

4110 MANTLE RIDGE DR
CUMMING GA
30041-5652
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-8311
  • Fax:
Mailing address:
  • Phone: 404-394-9755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN256792
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: