Healthcare Provider Details

I. General information

NPI: 1558925933
Provider Name (Legal Business Name): KENDRA GIPSON WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 HIGHLANDS PKWY SE STE 420
SMYRNA GA
30082-5192
US

IV. Provider business mailing address

817 47TH PL S
BIRMINGHAM AL
35222-3803
US

V. Phone/Fax

Practice location:
  • Phone: 678-424-1123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-159565
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1-159565
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number306219
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: