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General NPI Number Information
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NPI Number | 1194208355
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Entity Type | Individual
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Provider Name | LARAINE KISER PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/12/2018
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Last Update Date | 10/21/2022
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Provider Practice Location Address
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Address Line | 800 TALBOTTON RD
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City | COLUMBUS
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State | GA
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Zip | 31904-8946
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Country | US
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Telephone | 706-321-0495
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 51
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City | MIDLAND
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State | GA
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Zip | 31820-0051
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Country | US
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Telephone | 775-378-7236
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-08264
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 10638
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License Number State | GA
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