MEDICARE: KMZ HEALTHCARE & WELLNESS

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

General Provider Information

NPI Number	:	1356189310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KMZ HEALTHCARE & WELLNESS

Provider Business Mailing Address
First Line	:	232 SEATON AVE
Second Line	:
City	:	GROVETOWN
State	:	GA
Zip	:	30813-4259
Country	:	US
Telephone Number	:	478-494-8441
Fax Number	:

Provider Business Practice Location Address
First Line	:	1209 AUGUSTA WEST PKWY
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-1877
Country	:	US
Telephone Number	:	478-494-8441
Fax Number	:

Authorized Official
Title or Position	:	FAMILY NURSE PRACTITIONER
Name	:	KYTRENA LASHEL HARRIS
Credential	:	MSN, FNP-C
Telephone Number	:	478-494-8441

Provider Enumeration Date	:	07/16/2024
Last Update Date	:	07/16/2024

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Directions to “KMZ HEALTHCARE & WELLNESS ” Practice Location

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