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General NPI Number Information
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NPI Number | 1679463301
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Entity Type | Individual
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Provider Name | KRISTEN MARIE NAWYN AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/04/2025
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Last Update Date | 07/04/2025
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Provider Practice Location Address
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Address Line | 1876 N BROAD ST
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City | FUQUAY VARINA
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State | NC
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Zip | 27526-3657
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Country | US
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Telephone | 984-265-2101
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Fax |
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Provider Business Mailing Address
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Address Line | 302 AVERROE DR
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City | APEX
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State | NC
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Zip | 27502-4471
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Country | US
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Telephone | 313-566-3401
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 341674
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License Number State | NC
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