MEDICARE: KANDELOREA STARR PIERCE APRN, NP-C

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	363L00000X	Nurse Practitioner	RN242669	GA
2	363LF0000X	Family Nurse Practitioner	RN242669	GA
3	363LF0000X	Family Nurse Practitioner	APRN11021197	FL
4	363LF0000X	Family Nurse Practitioner	AC004079	MD

General Provider Information

NPI Number	:	1679056543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANDELOREA STARR PIERCE APRN, NP-C

Provider Business Mailing Address
First Line	:	4300 N POINT PKWY STE 300
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30022-4102
Country	:	US
Telephone Number	:	770-442-1911
Fax Number	:

Provider Business Practice Location Address
First Line	:	1150 HAMMOND DR STE 310
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-7500
Country	:	US
Telephone Number	:	678-802-5780
Fax Number	:

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

Provider Enumeration Date	:	09/07/2018
Last Update Date	:	05/09/2024

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