Kenyotter Whipple
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Macon, GA
NPI 1356755128 · NPPES record last updated Jun 25, 2020
Key facts
- NPI
- 1356755128
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- RN246767 (GA)
- Practice address
- 1400 Gray Hwy Apt 808
Macon, GA 31211-1931 - Phone
- (478) 258-8585
- NPI assigned
- Jun 19, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200408003520 | GA | Practitioner - Nurse Practitioner | 1759710965 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN246767 | GA | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Uhs of Anchor L.P. | Current |
Accepting new patients | |
| River Edge Behavioral Health Center | Current |
Accepting new patients | |
| Inner Community Health | Current |
Accepting new patients | |
| Personal Recovery Network LLC | Current |
Accepting new patients | |
| Uhs of Anchor L.P. | Current | Accepting new patients | |
| Advanced Anesthesia Associates, PC | Past |
Accepting new patients |
Locations
5454 Yorktowne Dr
College Park, GA 30349
Phone (678) 251-3200
2180 Satellite Blvd
Ste 400
Duluth, GA 30097
Phone (770) 256-3765
10700 Medlock Bridge Rd
Ste 104
Johns Creek, GA 30097
Phone (770) 476-9885
175 Emery Hwy
Macon, GA 31217
Phone (478) 751-4446
223 Medical Center Dr
Riverdale, GA 30274
Phone (770) 692-3554
83 Upper Riverdale Rd SW
Ste 300
Riverdale, GA 30274
Phone (678) 284-5620
7741 Roswell Rd
Sandy Springs, GA 30350
Phone (404) 612-2273
250 Corporate Center Ct
Stockbridge, GA 30281
Phone (770) 954-8685
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | RN246767 | GA | Yes |
Addresses
Primary practice location
1400 Gray Hwy Apt 808
Macon, GA 31211-1931
Mailing address
PO Box 27901
Macon, GA 31221-7901
Phone (478) 259-6319
Other providers in Macon, GA
- Melanie Wheeler
- Michael Chandler Wheeler
- Kristen Whelchel
- Tawanda Nacole Whidby
- Alexus Whipple
- Monique Whipple
- Barbara Michelle Whisenant
- Deborah Whitby
- Michell Whitby
- Benjamin Parker White
All providers in Macon, GA · Psychiatric/Mental Health Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 25, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.