Basic Information
Provider Information
NPI: 1134474844
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FOSKEY
FirstName: KALINA
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2121A BELLEVUE RD
Address2:  
City: DUBLIN
State: GA
PostalCode: 310212998
CountryCode: US
TelephoneNumber: 4782756811
FaxNumber: 4782756645
Practice Location
Address1: 2121A BELLEVUE RD
Address2:  
City: DUBLIN
State: GA
PostalCode: 310212998
CountryCode: US
TelephoneNumber: 4782756811
FaxNumber: 4782756645
Other Information
ProviderEnumerationDate: 07/18/2012
LastUpdateDate: 07/18/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WP0809XRN22537GAY Nursing Service ProvidersRegistered NursePsych/Mental Health, Adult

No ID Information.


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