Healthcare Provider Details

I. General information

NPI: 1487890349
Provider Name (Legal Business Name): KELDA MARIE KEMP RN, MSN, ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/25/2008
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 DEKALB MEDICAL PKWY
LITHONIA GA
30058-4996
US

IV. Provider business mailing address

2439 LENORA RD
LOGANVILLE GA
30052-2539
US

V. Phone/Fax

Practice location:
  • Phone: 404-686-1000
  • Fax:
Mailing address:
  • Phone: 404-422-1748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number170487
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number170487
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: