Provider Demographics
NPI:1386326981
Name:GARNER, KISHA NICOLE (NP)
Entity type:Individual
Prefix:
First Name:KISHA
Middle Name:NICOLE
Last Name:GARNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KISHA
Other - Middle Name:NICOLE
Other - Last Name:LEVY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2730 PEACHTREE INDUSTRIAL BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8627
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2730 PEACHTREE INDUSTRIAL BLVD STE 105
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-8627
Practice Address - Country:US
Practice Address - Phone:404-786-3845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN198519363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health