Healthcare Provider Details

I. General information

NPI: 1598068637
Provider Name (Legal Business Name): REBECCA YOUNGBLOOD KERSHNER WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2010
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 LANEY WALKER BLVD
AUGUSTA GA
30901-2960
US

IV. Provider business mailing address

1916 N LEG RD BLDG A
AUGUSTA GA
30909-4402
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-5931
  • Fax:
Mailing address:
  • Phone: 706-667-4285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN207255
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN207255
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: