MEDICARE: ASHLEY KISH AGACNP-BC

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	363LA2100X	Acute Care Nurse Practitioner	RN209909	GA

General Provider Information

NPI Number	:	1295112662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY KISH AGACNP-BC

Provider Business Mailing Address
First Line	:	1575 RIDENOUR PKWY NW
Second Line	:	APT 2306
City	:	KENNESAW
State	:	GA
Zip	:	30152-4714
Country	:	US
Telephone Number	:	678-358-3347
Fax Number	:

Provider Business Practice Location Address
First Line	:	2727 PACES FERRY RD SE
Second Line	:	SUITE 1-1100
City	:	ATLANTA
State	:	GA
Zip	:	30339-4053
Country	:	US
Telephone Number	:	404-605-4602
Fax Number	:

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

Provider Enumeration Date	:	05/05/2015
Last Update Date	:	05/05/2015

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