Provider Demographics
NPI:1174052120
Name:MCCARTHY, KRYSTLE KVALHEIM (NP-C)
Entity type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:KVALHEIM
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KRYSTLE
Other - Middle Name:DANILLE
Other - Last Name:KVALHEIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:5400 SUTLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4721
Mailing Address - Country:US
Mailing Address - Phone:912-354-6187
Mailing Address - Fax:
Practice Address - Street 1:225 CANDLER DR STE 300
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6091
Practice Address - Country:US
Practice Address - Phone:912-354-6187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN215848163WE0003X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003192231BMedicaid
GARN215848OtherGA RN LICENSE