Individual
CONSWALIS L. NORTHCUTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1719 RUSSELL PKWY, BLDG 700, WARNER ROBINS, GA 31088-5763
(478) 328-7674
(478) 328-1393
Mailing address
1719 RUSSELL PKWY, BLDG 700, WARNER ROBINS, GA 31088-5763
(478) 328-7674
(478) 328-1393
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
APRN-NP203938
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AG0815122
CERTIFICATION NUMBER (AMERICAN ACADEMY OF NURSE PRACTITIONERS)
GA
01
—
RN203938
NURSE PRACTIONER LICENSURE NUMBER
GA
Enumeration date
06/15/2016
Last updated
11/04/2025
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