Provider Demographics
NPI:1407128937
Name:DOYLE, KONNIE M (NP-C)
Entity Type:Individual
Prefix:MS
First Name:KONNIE
Middle Name:M
Last Name:DOYLE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WILLOW LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-8523
Mailing Address - Country:US
Mailing Address - Phone:478-971-4934
Mailing Address - Fax:
Practice Address - Street 1:3001 RICHARD B RUSSELL PKWY
Practice Address - Street 2:CVS MINUTE CLINIC
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8657
Practice Address - Country:US
Practice Address - Phone:478-953-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN110538363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily