Healthcare Provider Details

I. General information

NPI: 1952158404
Provider Name (Legal Business Name): KAETLIN HERMES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAETLIN WENINGER

II. Dates (important events)

Enumeration Date: 05/02/2024
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3965 HOLCOMB BRIDGE RD STE 100
PEACHTREE CORNERS GA
30092-2203
US

IV. Provider business mailing address

11611 E ARLINGTON RD
HAVEN KS
67543-8044
US

V. Phone/Fax

Practice location:
  • Phone: 770-450-8677
  • Fax:
Mailing address:
  • Phone: 620-899-4843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: