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NPI Code Detail

MEDICARE: KIMBERLY TYRA LANIER APRN CNS/PMH

MEDICARE: KIMBERLY TYRA LANIER APRN CNS/PMH
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
1163W00000XRegistered NurseRN119081GA
2363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN-CNS-PMH119081GA

General Provider Information

NPI Number : 1144558404
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY TYRA LANIER APRN CNS/PMH
Provider Business Mailing Address
First Line : 5965 PARKWAY NORTH BLVD STE C
Second Line :
City : CUMMING
State : GA
Zip : 30040-1431
Country : US
Telephone Number : 770-475-8014
Fax Number : 770-886-0404
Provider Business Practice Location Address
First Line : 5965 PARKWAY NORTH BLVD STE C
Second Line :
City : CUMMING
State : GA
Zip : 30040-1431
Country : US
Telephone Number : 770-475-8014
Fax Number : 770-886-0404
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/25/2009
Last Update Date : 10/27/2025

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