Provider Demographics
NPI:1932794922
Name:KIND, LISHONDER G
Entity type:Individual
Prefix:
First Name:LISHONDER
Middle Name:G
Last Name:KIND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISHONDER
Other - Middle Name:GAIL
Other - Last Name:KIND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN,NP
Mailing Address - Street 1:12734 CATTAIL CT
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-2611
Mailing Address - Country:US
Mailing Address - Phone:229-415-5319
Mailing Address - Fax:
Practice Address - Street 1:12734 CATTAIL CT
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-2611
Practice Address - Country:US
Practice Address - Phone:229-415-5319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA246345363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology