Individual
KALEISE TENNILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
2002 TIFT AVE N, TIFTON, GA 31794-1824
(229) 463-7071
(833) 606-0577
Mailing address
4196 HIGHWAY 62 412, HARDY, AR 72542-8002
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN207468
GA
363LF0000X
Family Nurse Practitioner
Primary
207468
GA
Other
Enumeration date
12/13/2019
Last updated
08/31/2022
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