Active NPI
Kelly Wiedower
- Family Nurse Practitioner
- Greensboro, GA
National Provider Identifier
1629528450
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 213342
- Practice address
- 1041 Park Dr
Greensboro, GA 30642-3465 - Phone
- (706) 453-4945
- NPI assigned
- Oct 5, 2016
- Last updated
- Oct 5, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 213342 | GA | Primary |
Addresses
Primary practice location
1041 Park Dr
Greensboro, GA 30642-3465
Mailing address
1081 Princeton LN
Watkinsville, GA 30677-5338
Phone (706) 254-3250
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1475625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475625600000",
"number": "1629528450",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1081 PRINCETON LN",
"city": "WATKINSVILLE",
"state": "GA",
"postal_code": "306775338",
"telephone_number": "706-254-3250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1041 PARK DR",
"city": "GREENSBORO",
"state": "GA",
"postal_code": "306423465",
"telephone_number": "706-453-4945"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIEDOWER",
"first_name": "KELLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-10-05",
"last_updated": "2016-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "GA",
"license": "213342",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greensboro, GA
- Holly J Warnock, PT
- Ramona Dean Warren, D.C.
- Thomas W Wehmann, DO
- Charles Cody White IV, MD
- Tressa Pause White, RPH
- William Moore Jr DMD LLC (Moore Family & Cosmetic Dentistry)
- Brian K Williams, PA-C
- Kathryn K Williford, M.D.
- Tamara Wojciechowski, PHDC, CRNA, FAAPM
- Cynthia Goodwin Womack, DHS, MN.LMFT,CNS/PMH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.