Individual
KIMBERLY NATASHIA MICKENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
275A THOMSON RD, WASHINGTON, GA 30673-4313
(706) 338-8350
Mailing address
502 NORTHLANDS LN, EVANS, GA 30809-6695
(706) 338-8350
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
LPN099093
GA
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
LPN099093
GA
251E00000X
Home Health Agency
LPN099093
GA
251J00000X
Nursing Care Agency
LPN099093
GA
261QD1600X
Developmental Disabilities Clinic/Center
LPN099093
GA
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
LPN099093
GA
Other
Enumeration date
10/06/2023
Last updated
10/06/2023
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