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Individual

KYMBERLY D ANDERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
204 E 15TH ST, ALMA, GA 31510-2908
(912) 632-2952
Mailing address
204 E 15TH ST, ALMA, GA 31510-2908
(912) 632-2952

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN149756
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003174390A
GA
01
202I509677
MEDICARE PTAN
GA
Enumeration date
12/10/2015
Last updated
04/13/2017
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