Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN187630 | GA |
NPI | 1003216045 |
---|---|
Provider Name | Jackie M Kehrli |
First Address | Savannah, GA 31404-6278 |
Second Address | Savannah, GA 31404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2014 |
Last Update Date | 07/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003176168A | (05) | GA |