Healthcare Provider Details

I. General information

NPI: 1295112662
Provider Name (Legal Business Name): ASHLEY KISH AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 PACES FERRY RD SE SUITE 1-1100
ATLANTA GA
30339-4053
US

IV. Provider business mailing address

1575 RIDENOUR PKWY NW APT 2306
KENNESAW GA
30152-4714
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-4602
  • Fax:
Mailing address:
  • Phone: 678-358-3347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN209909
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: