Healthcare Provider Details

I. General information

NPI: 1467189258
Provider Name (Legal Business Name): SUMMER ELIZABETH KERVIN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 JIM MASON CT STE A
WARNER ROBINS GA
31088-8965
US

IV. Provider business mailing address

328 WAXMYRTLE WAY
PERRY GA
31069-9478
US

V. Phone/Fax

Practice location:
  • Phone: 478-474-2947
  • Fax:
Mailing address:
  • Phone: 334-945-0105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN314188
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberRN314188
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: