Provider Demographics
NPI:1295548006
Name:SOUTHER, KRISTEN (MSN, RN CPNP-PC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:SOUTHER
Suffix:
Gender:F
Credentials:MSN, RN CPNP-PC
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5546 BARK CAMP RD
Mailing Address - Street 2:
Mailing Address - City:MURRAYVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30564-1804
Mailing Address - Country:US
Mailing Address - Phone:770-654-4953
Mailing Address - Fax:
Practice Address - Street 1:300 DAWSON COMMONS CIR STE 320
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6268
Practice Address - Country:US
Practice Address - Phone:706-216-2771
Practice Address - Fax:706-216-2944
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-28
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN258617163W00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse