MEDICARE: JANICE K HOGUE KINAHAN NP

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	363L00000X	Nurse Practitioner	RN087295	GA

General Provider Information

NPI Number	:	1760559512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE K HOGUE KINAHAN NP

Provider Business Mailing Address
First Line	:	1301 SHILOH RD NW
Second Line	:	STE 1611
City	:	KENNESAW
State	:	GA
Zip	:	30144-7147
Country	:	US
Telephone Number	:	770-804-9479
Fax Number	:	877-795-9149

Provider Business Practice Location Address
First Line	:	1301 SHILOH RD NW
Second Line	:	STE 1611
City	:	KENNESAW
State	:	GA
Zip	:	30144-7147
Country	:	US
Telephone Number	:	770-804-9479
Fax Number	:	877-795-9149

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	02/13/2015

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