Healthcare Provider Details

I. General information

NPI: 1134520984
Provider Name (Legal Business Name): KRISTIN LAMB FENN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1247 S 1ST ST
JESUP GA
31545-7729
US

IV. Provider business mailing address

1247 S 1ST ST
JESUP GA
31545-7729
US

V. Phone/Fax

Practice location:
  • Phone: 912-385-2739
  • Fax:
Mailing address:
  • Phone: 912-385-2739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP210229
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: