Individual
KAMIE D THEOBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
500 BROOKSTONE CENTRE PARKWAY, #100, COLUMBUS, GA 31904
(706) 221-4602
(706) 221-4620
Mailing address
500 BROOKSTONE CENTRE PARKWAY, #100, COLUMBUS, GA 31904
(706) 221-4602
(706) 221-4620
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN149771
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00310414E
—
GA
01
—
RN149771
LICENSE
GA
Enumeration date
10/22/2009
Last updated
06/02/2022
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