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General NPI Number Information
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NPI Number | 1073700886
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Entity Type | Individual
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Provider Name | IVEY BROXTON NP
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Gender | Female
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 1150 GOLDEN WAY
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City | WATKINSVILLE
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State | GA
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Zip | 30677-7712
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Country | US
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Telephone | 706-612-9401
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Fax | 706-612-9420
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Provider Business Mailing Address
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Address Line | 1150 GOLDEN WAY
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City | WATKINSVILLE
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State | GA
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Zip | 30677-7712
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Country | US
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Telephone | 706-612-9401
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Fax | 706-612-9420
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN-NP165181
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License Number State | GA
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