Individual
KIMBERLY WAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 S HOUSTON LAKE RD, WARNER ROBINS, GA 31088-9006
(478) 953-6727
Mailing address
200 S HOUSTON LAKE RD, WARNER ROBINS, GA 31088-9006
(478) 955-1592
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN208988
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F0515490
CERTIFICATION NUMBER (AMERICAN ACADEMY NURSE PRACTITIONERS)
GA
01
—
RN208988
GA STATE NURSE PRACTITIONER LICENSURE
GA
Enumeration date
06/12/2015
Last updated
06/12/2015
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