Individual
KELLIE WHITENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
23702 HWY 80 E, STATESBORO, GA 30461-0845
(912) 489-4090
(912) 764-5028
Mailing address
23702 HWY 80 E, STATESBORO, GA 30461-0845
(912) 489-4090
(912) 764-8378
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN213296
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN213296
GEORGIA LICENSE
GA
Enumeration date
12/16/2020
Last updated
12/16/2020
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