Provider Demographics
NPI:1538038385
Name:MCKISIC, VALERIE LATRICE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:LATRICE
Last Name:MCKISIC
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 GREEN VALLEY CIR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-3621
Mailing Address - Country:US
Mailing Address - Phone:404-860-3545
Mailing Address - Fax:
Practice Address - Street 1:35 GREEN VALLEY CIR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-3621
Practice Address - Country:US
Practice Address - Phone:404-860-3545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-31
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF10250934363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty