Provider Demographics
NPI:1477911386
Name:MCCIER, KHELSEA M (CPNP (NP))
Entity Type:Individual
Prefix:
First Name:KHELSEA
Middle Name:M
Last Name:MCCIER
Suffix:
Gender:F
Credentials:CPNP (NP)
Other - Prefix:
Other - First Name:KHELSEA
Other - Middle Name:
Other - Last Name:DODDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:MEDLOCK PEDIATRICS: 3497 DULUTH PARK LANE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096
Mailing Address - Country:US
Mailing Address - Phone:770-826-4760
Mailing Address - Fax:
Practice Address - Street 1:MEDLOCK PEDIATRICS: 3497 DULUTH PARK LANE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096
Practice Address - Country:US
Practice Address - Phone:770-826-4760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-05
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN210408363LP0200X
GA210408363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics