Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 191978 | GA |
N | 363LG0600X | Nurse Practitioner - Gerontology | RN 191978 | GA |
NPI | 1073875910 |
---|---|
Provider Name | Melissa Audy |
First Address | Louisville, KY 40299-2361 |
Second Address | Atlanta, GA 30309-1304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2012 |
Last Update Date | 29/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003130471A | (05) | GA |