KRISTEN GRACE VAN WATERS FNP-BC
NPI 1629961776
Nurse Practitioner - Family in Canton, GA

Active since May 29, 2025
111 MOUNTAIN BROOK DR, CANTON, GA 30115(678) 880-9654 Get Directions Write a Review

NPPES record last updated: May 29, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Kristen Grace Van Waters Fnp-bc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KRISTEN GRACE VAN WATERS FNP-BC (NPI 1629961776) is an individual family provider in Canton, Georgia, licensed in Georgia (RN266451) and active in the NPI registry since May 2025.

NPPES Registry Identity

NPI1629961776
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameKRISTEN GRACE VAN WATERSCredential: FNP-BC
Location Address111 MOUNTAIN BROOK DRCanton, GA 30115-9045
Mailing Address3760 Station Dr NwKennesaw, GA 30144-2141 · (812) 821-3882
Sole ProprietorNo
Enumeration DateMay 29, 2025
NPPES CertifiedMay 29, 2025
NPI 1629961776 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License Licensed in GA · RN266451
111 MOUNTAIN BROOK DR, Canton, GA 30115

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Physician Assistant
111 MOUNTAIN BROOK DR
CANTON, GA 30115
Nurse Practitioner (Family)
111 MOUNTAIN BROOK DR
CANTON, GA 30115
Pediatrics
111 MOUNTAIN BROOK DR
CANTON, GA 30115
Nurse Practitioner
111 MOUNTAIN BROOK DR
CANTON, GA 30115

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kristen Van Waters's NPI number?

The NPI number for Kristen Van Waters is 1629961776. It was assigned to this individual provider in the NPPES registry on May 29, 2025.

Where is Kristen Van Waters located?

Kristen Van Waters practices at 111 Mountain Brook Dr, Canton, GA 30115. The listed phone number is (678) 880-9654.

What is Kristen Van Waters's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

When was this NPI record last updated?

The NPPES record for Kristen Van Waters was last updated on May 29, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.