Aileen M Anom, NP
Individual provider Active NPI Family Nurse Practitioner · Tucker, GA
NPI 1376531723 · NPPES record last updated Feb 9, 2022
Key facts
- NPI
- 1376531723
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- RN113842 (GA)
- Practice address
- 200 Crescent Center Parkway
Kaiser Permanente Crescent Medical Center
Tucker, GA 30084 - Phone
- (770) 496-3414
- NPI assigned
- Oct 10, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN113842 | GA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| David E Kim MD PC | Past |
Accepting new patients | |
| The Healthcaring Clinic of Georgia, LLC | Family | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN113842 | GA | Yes |
Addresses
Primary practice location
200 Crescent Center Parkway
Kaiser Permanente Crescent Medical Center
Tucker, GA 30084
Mailing address
3495 Piedmont Road, NE
Nine Piedmont Center
Atlanta, GA 30305
Phone (404) 504-5678
Other names
- Aileen M Wideman
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq | Health Information Exchange (HIE) |
Other providers in Tucker, GA
- Ams Vans Inc
- Ams Vans LLC
- Angel I a M Care, Inc.
- Jacqueline M Anglade
- Ann Waters, LPC, LLC
- Another Chance Rehabilitation Services Inc
- Applied Home Care
- Nita Arias
- Robin R Armenia
- Om P Arora
All providers in Tucker, GA · Family 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 Feb 9, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.