Provider Demographics
NPI:1619334562
Name:COLE, KIMBERLEY RENEE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:RENEE
Last Name:COLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:575 PROFESSIONAL DRIVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046
Mailing Address - Country:US
Mailing Address - Phone:770-616-2760
Mailing Address - Fax:678-312-5289
Practice Address - Street 1:575 PROFESSIONAL DR.
Practice Address - Street 2:SUITE 150
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046
Practice Address - Country:US
Practice Address - Phone:678-312-5200
Practice Address - Fax:678-312-5289
Is Sole Proprietor?:No
Enumeration Date:2016-01-23
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN139658163W00000X, 208VP0000X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily