Provider Demographics
NPI:1760466783
Name:DEAVERS, KATHERINE POWE (RN, MS, FNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:POWE
Last Name:DEAVERS
Suffix:
Gender:F
Credentials:RN, MS, FNP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:KATHERINE
Other - Last Name:POWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MS, FNP
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:655 JESSE JEWELL PKWY SE STE B
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3854
Practice Address - Country:US
Practice Address - Phone:678-207-4500
Practice Address - Fax:770-536-0383
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN100964363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA571471OtherWELLCARE
GA738974330BMedicaid
GA738974330CMedicaid
GAP00847058OtherMEDICARE RAILROAD
GA01341907OtherAMERIGROUP
GAQ24294Medicare UPIN
GA738974330CMedicaid