MEDICARE: LILIYA KYRYCHENKO NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN176429	GA

General Provider Information

NPI Number	:	1124766282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILIYA KYRYCHENKO NP-C

Provider Business Mailing Address
First Line	:	3715 NORTHSIDE PKWY NW STE 2-100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-2809
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3715 NORTHSIDE PKWY NW STE 2-100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-2809
Country	:	US
Telephone Number	:	770-938-1757
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2022
Last Update Date	:	05/26/2022

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