Washington, Kethia Shanelle

Washington, Kethia Shanelle is an individual health care provider with primary practice located at 985 Taylor St Sw , Conyers GA 30012-5357. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Washington, Kethia Shanelle can be contacted via phone (770) 785-4345.

Contact Information

Primary practice address
985 Taylor St Sw Conyers GA 30012-5357
Phone: (770) 785-4345
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X 204948 Georgia
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X RN204948 Georgia

Profile Details

NPI number 1376891267
LBN Legal business name Washington, Kethia Shanelle
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 27th, 2012
Last updated Dec 12th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1376891267 NPPES
Georgia MEDICAID 000456486A

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