Healthcare Provider Details

I. General information

NPI: 1366023046
Provider Name (Legal Business Name): KERI TUTEN HALE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 BOULEVARD SQ STE D
WAYCROSS GA
31501-8022
US

IV. Provider business mailing address

2392 NURSERY RD
BLACKSHEAR GA
31516-4688
US

V. Phone/Fax

Practice location:
  • Phone: 912-387-0445
  • Fax:
Mailing address:
  • Phone: 912-670-0480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN248323
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: