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NPI Code Detail

MEDICARE: KATHLEEN NICKERSON RDH

MEDICARE: KATHLEEN NICKERSON RDH
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
1124Q00000XDental HygienistDH002903GA

General Provider Information

NPI Number : 1679388151
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN NICKERSON RDH
Provider Business Mailing Address
First Line : 5601 VETERANS PKWY
Second Line :
City : COLUMBUS
State : GA
Zip : 31904-9001
Country : US
Telephone Number : 706-321-6190
Fax Number : 706-252-3008
Provider Business Practice Location Address
First Line : 5601 VETERANS PKWY
Second Line :
City : COLUMBUS
State : GA
Zip : 31904-9001
Country : US
Telephone Number : 706-321-6190
Fax Number : 706-252-3008
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2025
Last Update Date : 02/11/2025

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