Provider Demographics
NPI:1598476491
Name:POLONEY, KIARA NICOLE (NP)
Entity Type:Individual
Prefix:MRS
First Name:KIARA
Middle Name:NICOLE
Last Name:POLONEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KIARA
Other - Middle Name:NICOLE
Other - Last Name:MILANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:5538 RIVER VALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-5199
Mailing Address - Country:US
Mailing Address - Phone:678-977-1694
Mailing Address - Fax:
Practice Address - Street 1:5538 RIVER VALLEY WAY
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-5199
Practice Address - Country:US
Practice Address - Phone:678-977-1694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704375490363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily