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General NPI Number Information
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NPI Number | 1639414188
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Entity Type | Individual
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Provider Name | KACI ABSALOM NP
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Gender | Female
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Dates
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Enumeration Date | 12/10/2012
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Last Update Date | 02/14/2018
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Provider Practice Location Address
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Address Line | 5009 RIVERCHASE DR STE 500
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City | PHENIX CITY
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State | AL
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Zip | 36867-7490
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Country | US
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Telephone | 334-448-9505
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Fax | 334-448-9575
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Provider Business Mailing Address
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Address Line | 5009 RIVERCHASE DR STE 500
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City | PHENIX CITY
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State | AL
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Zip | 36867-7490
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Country | US
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Telephone | 334-448-9505
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Fax | 334-448-9575
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN177275
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1-111962
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License Number State | AL
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