=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366023046
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KERI TUTEN HALE NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2021
-----------------------------------------------------
Last Update Date | 06/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1701 BOULEVARD SQ STE D
-----------------------------------------------------
City | WAYCROSS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31501-8022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-387-0445
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2392 NURSERY RD
-----------------------------------------------------
City | BLACKSHEAR
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31516-4688
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-670-0480
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | RN248323
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------