Provider Demographics
NPI:1073326658
Name:LE, KIMBERLY LOAN (NP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LOAN
Last Name:LE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5422 CUMMING HWY STE 204
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-7029
Mailing Address - Country:US
Mailing Address - Phone:478-960-6954
Mailing Address - Fax:
Practice Address - Street 1:5422 CUMMING HWY STE 204
Practice Address - Street 2:
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-7029
Practice Address - Country:US
Practice Address - Phone:478-960-6954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN260301363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology