Individual
MISS KELLI NICOLE BROADUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1 FREEDOM WAY, AUGUSTA, GA 30904-6258
(706) 733-0188
Mailing address
1330 ROYAL OAK ST, GROVETOWN, GA 30813-3996
(706) 726-0907
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN216907
GA
Other
Enumeration date
04/25/2017
Last updated
04/25/2017
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