Healthcare Provider Details

I. General information

NPI: 1669840971
Provider Name (Legal Business Name): KACIE DINGLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 JEFFERSON PKWY
NEWNAN GA
30263-5823
US

IV. Provider business mailing address

189 JEFFERSON PKWY
NEWNAN GA
30263-5823
US

V. Phone/Fax

Practice location:
  • Phone: 770-304-2220
  • Fax:
Mailing address:
  • Phone: 770-304-2220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN162164
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRN162164
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: