MEDICARE: MS. KRISTEN LEE NYE DAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	611	GA

General Provider Information

NPI Number	:	1164373940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTEN LEE NYE DAC

Provider Business Mailing Address
First Line	:	3525 MALL BLVD STE 5A1
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-4727
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3525 MALL BLVD STE 5A1
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-4727
Country	:	US
Telephone Number	:	470-723-4866
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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