Individual
KELLY TICKLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PCNS-BC, PPCNP-BC
Contact information
Practice address
5455 MERIDIAN MARKS RD STE 400, ATLANTA, GA 30342-4723
(404) 785-3240
(404) 785-3600
Mailing address
5455 MERIDIAN MARKS RD STE 400, ATLANTA, GA 30342-4723
(404) 785-3240
(404) 785-3600
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN228738
GA
363LP0200X
Pediatric Nurse Practitioner
Primary
APRN-NP228738
GA
364SP0200X
Pediatric Clinical Nurse Specialist
APRN-CNS228738
GA
Other
Enumeration date
01/08/2014
Last updated
10/31/2025
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