Provider Demographics
NPI:1376652107
Name:MCKUNE, KELLY THERESA (CNM)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:THERESA
Last Name:MCKUNE
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Gender:F
Credentials:CNM
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Mailing Address - Street 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:
Practice Address - Street 1:3550 PRESTON RIDGE RD
Practice Address - Street 2:KAISER PERMANENTE ALPHARETTA MEDICAL OFFICE
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3821
Practice Address - Country:US
Practice Address - Phone:773-296-7032
Practice Address - Fax:773-296-3096
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2022-01-07
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Provider Licenses
StateLicense IDTaxonomies
IL209005171367A00000X
GARN140331367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL41.310797Medicaid