Healthcare Provider Details

I. General information

NPI: 1710753082
Provider Name (Legal Business Name): KENYANA SUZAN NIKIA WESLEY AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 TREE LN STE 250
SNELLVILLE GA
30078-6799
US

IV. Provider business mailing address

3310 SHULER RD
GAINESVILLE GA
30506-1478
US

V. Phone/Fax

Practice location:
  • Phone: 770-736-6300
  • Fax:
Mailing address:
  • Phone: 770-533-1694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-NP295691
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: