Provider Demographics
NPI:1598273377
Name:DE LA CRUZ, KALEIGH S (NP)
Entity Type:Individual
Prefix:
First Name:KALEIGH
Middle Name:S
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:6701 BAUM DR
Mailing Address - Street 2:STE 140
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-7361
Mailing Address - Country:US
Mailing Address - Phone:865-584-5727
Mailing Address - Fax:865-450-9904
Practice Address - Street 1:105 BRIARCLIFF RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-4039
Practice Address - Country:US
Practice Address - Phone:478-922-8900
Practice Address - Fax:478-922-8989
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-16
Last Update Date:2019-03-05
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Provider Licenses
StateLicense IDTaxonomies
GA1776363L00000X
GA049978GA207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty