MEDICARE: KIM CUNNINGHAM APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2025031612	GA

General Provider Information

NPI Number	:	1205236320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM CUNNINGHAM APRN

Provider Business Mailing Address
First Line	:	4312 SANDERLING DR
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30906-8514
Country	:	US
Telephone Number	:	706-513-4389
Fax Number	:

Provider Business Practice Location Address
First Line	:	4312 SANDERLING DR
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30906-8514
Country	:	US
Telephone Number	:	706-513-4389
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2014
Last Update Date	:	03/05/2026

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