Provider Demographics
NPI:1609230069
Name:KISER, KENNETH LINDSEY (APRN)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:LINDSEY
Last Name:KISER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5470 SERENDIPITY TRL
Mailing Address - Street 2:
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632-3465
Mailing Address - Country:US
Mailing Address - Phone:229-415-5175
Mailing Address - Fax:
Practice Address - Street 1:2922 N OAK ST STE C
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1885
Practice Address - Country:US
Practice Address - Phone:229-262-6819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN066436363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care