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General NPI Number Information
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NPI Number | 1962247999
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Entity Type | Individual
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Provider Name | IZABELLA CUSHING TEMPLES NP
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Gender | Female
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Dates
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Enumeration Date | 07/01/2024
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Last Update Date | 07/01/2024
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Provider Practice Location Address
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Address Line | 11045 COLUMBIA ST
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City | BLAKELY
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State | GA
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Zip | 39823-3447
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Country | US
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Telephone | 229-723-4313
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Fax | 229-723-3700
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Provider Business Mailing Address
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Address Line | 11740 COLUMBIA ST
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City | BLAKELY
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State | GA
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Zip | 39823-2574
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Country | US
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Telephone | 229-724-4282
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Fax | 229-724-4283
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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 | RN303220
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License Number State | GA
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