Individual
KAYLA ELISE MOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGPCNP-C
Contact information
Practice address
190 MADISON AVE NE, LUDOWICI, GA 31316-5610
(912) 432-9954
Mailing address
190 MADISON AVE NE, LUDOWICI, GA 31316-5610
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN204201
GA
Other
Enumeration date
05/31/2017
Last updated
05/31/2017
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