Provider Demographics
NPI:1346522802
Name:VONHERBULIS, KELLY ANN (APRN-BC, NNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:VONHERBULIS
Suffix:
Gender:F
Credentials:APRN-BC, NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4750 WATERS AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6200
Mailing Address - Country:US
Mailing Address - Phone:912-350-5915
Mailing Address - Fax:912-350-5930
Practice Address - Street 1:4750 WATERS AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6200
Practice Address - Country:US
Practice Address - Phone:912-350-5915
Practice Address - Fax:912-350-5930
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN124495363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal