Provider Demographics
NPI:1073175923
Name:WITHROW, KIMBERLY SMITH (FNP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SMITH
Last Name:WITHROW
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:GA
Mailing Address - Zip Code:31035-6870
Mailing Address - Country:US
Mailing Address - Phone:478-232-4051
Mailing Address - Fax:
Practice Address - Street 1:1909 N COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2170
Practice Address - Country:US
Practice Address - Phone:478-295-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN240268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily