Individual
KYLA RENAE BLACKSHEAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1601 HARMON AVE., FORT STEWART, GA 31314
(912) 435-5924
Mailing address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(912) 435-6965
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
05/25/2023
Last updated
09/26/2024
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