Provider Demographics
NPI:1467653394
Name:LEVERETT, KIM R (APRN, BC)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:R
Last Name:LEVERETT
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:5278 ADAMS ST NE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2628
Mailing Address - Country:US
Mailing Address - Phone:770-786-2201
Mailing Address - Fax:770-786-0270
Practice Address - Street 1:5278 ADAMS ST NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2628
Practice Address - Country:US
Practice Address - Phone:770-786-2201
Practice Address - Fax:770-786-0270
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN140100 CNS PMH NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner