Provider Demographics
NPI:1033732755
Name:MALPHUS, KERA ASHLYN
Entity Type:Individual
Prefix:
First Name:KERA
Middle Name:ASHLYN
Last Name:MALPHUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 RICHEY LN
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31535-5916
Mailing Address - Country:US
Mailing Address - Phone:912-592-1320
Mailing Address - Fax:
Practice Address - Street 1:1001 WARD ST W
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2263
Practice Address - Country:US
Practice Address - Phone:912-384-7210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN265048363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner