Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | RN171399 | GA |
NPI | 1033558861 |
---|---|
Provider Name | Mrs. Kimberly A Harris |
First Address | Peachtree City, GA 30269-4047 |
Second Address | Roswell, GA 30076-3871 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2013 |
Last Update Date | 22/02/2016 |