=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669227948
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANSLEY ELIZABETH KIRKLAND NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2024
-----------------------------------------------------
Last Update Date | 04/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24 W CHATHAM CT
-----------------------------------------------------
City | GARDEN CITY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31408-3051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-446-1777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 164
-----------------------------------------------------
City | SAVANNAH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31402-0164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-618-0052
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN252060
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------