Healthcare Provider Details

I. General information

NPI: 1326962010
Provider Name (Legal Business Name): KRISTEN MARTIN DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 BOTTESFORD DR NW
KENNESAW GA
30144-7134
US

IV. Provider business mailing address

412 BOTTESFORD DR NW
KENNESAW GA
30144-7134
US

V. Phone/Fax

Practice location:
  • Phone: 706-273-6131
  • Fax:
Mailing address:
  • Phone: 706-273-6131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN-NP291801
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: