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General NPI Number Information
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NPI Number | 1528526548
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Entity Type | Individual
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Provider Name | KISHA MESHUN PEACE AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/08/2019
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 7823 SPIVEY STATION BLVD STE 360
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City | JONESBORO
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State | GA
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Zip | 30236-2886
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Country | US
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Telephone | 770-741-1750
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Fax | 770-741-1755
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Provider Business Mailing Address
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Address Line | 508 BETHELVIEW DR
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City | HAMPTON
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State | GA
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Zip | 30228-4825
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Country | US
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Telephone | 850-624-5436
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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 | 163WI0500X
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Taxonomy Name | Infusion Therapy Registered Nurse
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License Number | RN194819
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163WX0200X
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Taxonomy Name | Oncology Registered Nurse
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License Number | RN194819
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | NCO-000001
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | NCO-000001
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NCO-000001
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License Number State | GA
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