STEPHANIE L. CRICKENBERGER (NPI# 1992094130) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992094130 |
| Entity Type | Individual |
| Full Name | STEPHANIE L. CRICKENBERGER |
| Other Name | STEPHANIE C. MOORE |
| Credential | FNP |
| Practice Address |
61 Whitcher St Ne Suite 1100 Marietta GA 30060-1176 |
| Practice Telephone | 7704223290 |
| Practice Fax Number | 7704220287 |
| Mailing Telephone | 7704223290 |
| Mailing Fax Number | 7704220287 |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2020-08-24 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
RN102799 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 003122295C | 05 | |
| GA | 003122295D | 05 |
| Street Address |
61 WHITCHER ST NE SUITE 1100 |
| City | MARIETTA |
| State | GA |
| Zip Code | 30060-1176 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124014568 | Richard W Cohen | Orthopaedic Surgery | 61 Whitcher St Ne, Suite 1100, Marietta, GA 30060-1176 | 2005-09-21 |
| 1376050955 | Gina M Soto | Nurse Practitioner | 61 Whitcher St Ne, Marietta, GA 30060-1176 | 2018-01-04 |
| 1477062594 | Anna Swanson Bouchard | Nurse Practitioner | 61 Whitcher St Ne, Marietta, GA 30060-1176 | 2017-09-20 |
| 1396281200 | Trevor J Wallace | Physician Assistant | 61 Whitcher St Ne, Suite 1100, Marietta, GA 30060-1176 | 2017-01-17 |
| 1720537327 | Taylor Dellinger | Nurse Practitioner | 61 Whitcher St Ne, Suite 3110, Marietta, GA 30060-1176 | 2016-09-25 |
| 1164871117 | Georgiana Massad | Physician Assistant | 61 Whitcher St Ne, Suite 2100, Marietta, GA 30060-1176 | 2016-06-10 |
| 1134593809 | Sarah Applegarth | Physician Assistant | 61 Whitcher St Ne, Suite 2100, Marietta, GA 30060-1176 | 2015-11-18 |
| 1336543529 | Wellstar Medical Group, LLC | Internal Medicine | 61 Whitcher St Ne, Suite 4100b, Marietta, GA 30060-1181 | 2014-10-16 |
| 1346660198 | Catherine Chmiel | Nurse Practitioner | 61 Whitcher St Ne, Suite 4100, Marietta, GA 30060-1176 | 2014-04-20 |
| 1467885863 | Wellstar Medical Group, LLC | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 61 Whitcher St Ne, Suite 4100, Marietta, GA 30060-1176 | 2013-08-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144845116 | Legacy Center for Spinal Surgery, LLC | Neurological Surgery | 1900 The Exchange, Ne, Suite 600, Marietta, GA 30060 | 2020-06-15 |
| 1407477193 | Michael Cynil Daniel | Counselor | 698 N Marietta, Pkwy, Marietta, GA 30060 | 2020-05-04 |
| 1285253401 | Cameron Thomas Kennelly | Student in an Organized Health Care Education/Training Program | 677 Church Street Ne Attn:gme, Marietta, GA 30060 | 2020-04-09 |
| 1922640739 | Jeremiah George Blair | Physician Assistant | 61 Whitcher St Suite 2100, Marietta, GA 30060 | 2019-10-14 |
| 1164064945 | Denise Alicia Mick | Registered Nurse | 677 Church St Wellstar Kennestone Hospital, Marietta, GA 30060 | 2019-10-12 |
| 1184283772 | Iora Health Georgia, P.C. | Internal Medicine | 280 Cobb Pkwy Se, Suite 60, Marietta, GA 30060 | 2019-06-07 |
| 1346703212 | Caitlin Virginia Mueller | Student in an Organized Health Care Education/Training Program | 677 Church Street Ne, Attn: Gme, Marietta, GA 30060 | 2019-04-08 |
| 1184187205 | Adero Francis | Student in an Organized Health Care Education/Training Program | Wellstar Kennestone Gme Internal Medicine Clinic, 833 Campbell Hill St Nw, Suite 250, Marietta, GA 30060 | 2019-04-08 |
| 1659832749 | Matthew Mozzo | Student in an Organized Health Care Education/Training Program | 677 Church Street / Lower Level, Gme Department / I.m., Marietta, GA 30060 | 2019-03-29 |
| 1245797430 | La'myia Spentz | Specialist | 109 Anderson St Ne, Suite 608, Marietta, GA 30060 | 2019-02-25 |
| Find all providers in zip 30060 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619576931 | Dzintra Leblanc | Nurse Practitioner | 2583 Ballew Ct Ne, Marietta, GA 30062-4424 | 2020-10-19 |
| 1730786047 | Monique An-jel Rosser | Nurse Practitioner | 687 Johnson Ferry Rd # 7044, Marietta, GA 30068-4628 | 2020-10-08 |
| 1518564418 | Althea Bryan | Nurse Practitioner | 198 Rotherhithe Ln Nw, Marietta, GA 30066-3491 | 2020-10-04 |
| 1013523646 | Susan Wanjiku Kamau | Nurse Practitioner | 1579 Sage Ridge Dr, Marietta, GA 30064-5327 | 2020-09-18 |
| 1982217402 | Lisa Abbott | Nurse Practitioner | 580 Kurtz Rd, Marietta, GA 30066-5348 | 2020-08-25 |
| 1538796008 | Chinwe Christiana O'hara | Nurse Practitioner | 3079 Hidden Forest Ct Unit 3650, Marietta, GA 30066-3137 | 2020-03-25 |
| 1376197335 | Nicole I Crawford | Nurse Practitioner | 868 Cedar Rd, Marietta, SC 29661-9006 | 2019-07-29 |
| 1689138935 | Mobile Np, LLC | Nurse Practitioner | 1120 Heather Wood Ct, Marietta, GA 30062-2926 | 2019-01-30 |
| 1790258531 | Leslie Burns | Nurse Practitioner | 2910 Burnt Hickory Rd Nw, Marietta, GA 30064-1238 | 2019-01-04 |
| 1316428527 | Candice Murray | Nurse Practitioner | 2727 Wynford Ave Sw, Marietta, GA 30064 | 2018-08-25 |
| Find all providers in MARIETTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.