Healthcare Provider Details

I. General information

NPI: 1487610887
Provider Name (Legal Business Name): KIMBERLY L EASON WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE STE 1275
ATLANTA GA
30308-2240
US

IV. Provider business mailing address

550 PEACHTREE ST NE STE 1275
ATLANTA GA
30308-2240
US

V. Phone/Fax

Practice location:
  • Phone: 404-872-3121
  • Fax: 404-872-3119
Mailing address:
  • Phone: 404-872-3121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN112386
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: