Healthcare Provider Details

I. General information

NPI: 1710554464
Provider Name (Legal Business Name): MY HEALTH REASSURANCE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 GLYNN ST N
FAYETTEVILLE GA
30214-1191
US

IV. Provider business mailing address

P.O. BOX 142076
FAYETTEVILLE GA
30214
UM

V. Phone/Fax

Practice location:
  • Phone: 770-648-2148
  • Fax: 676-788-2856
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAYONA J MORELAND
Title or Position: OWNER
Credential: FNP-C
Phone: 770-648-2148