Healthcare Provider Details

I. General information

NPI: 1104306786
Provider Name (Legal Business Name): GERALDINE VUGHOSU NKWAIN BSN,RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W HOSPITAL RD
FORT EISENHOWER GA
30905-5741
US

IV. Provider business mailing address

300 W HOSPITAL RD
FORT EISENHOWER GA
30905-5741
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-5811
  • Fax:
Mailing address:
  • Phone: 706-787-5811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1059119
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAC004621
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61517290
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number813031
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: