MEDICARE: KRISTIN ASHELY BERDY

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	363LF0000X	Family Nurse Practitioner	RN242053	GA

General Provider Information

NPI Number	:	1851934657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN ASHELY BERDY

Provider Business Mailing Address
First Line	:	1780 PEACHTREE PKWY STE 302
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-6834
Country	:	US
Telephone Number	:	470-275-6230
Fax Number	:

Provider Business Practice Location Address
First Line	:	1780 PEACHTREE PKWY STE 302
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-6834
Country	:	US
Telephone Number	:	470-275-6230
Fax Number	:

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

Provider Enumeration Date	:	10/24/2019
Last Update Date	:	06/01/2022

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