Basic Information
| Provider Information | |||||||||
| NPI: | 1609230069 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KISER | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | LINDSEY | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5470 SERENDIPITY TRL | ||||||||
| Address2: | |||||||||
| City: | HAHIRA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 316323465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2294155175 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2922 N OAK ST STE C | ||||||||
| Address2: | |||||||||
| City: | VALDOSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 316021885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2292626819 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2016 | ||||||||
| LastUpdateDate: | 04/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | RN066436 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.