Provider Demographics
NPI:1760754485
Name:KJONNEROD, ANGELICA CECILIA (PA)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:CECILIA
Last Name:KJONNEROD
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:192 LINDQUIST ROAD
Mailing Address - Street 2:BLDG 412
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31315
Mailing Address - Country:US
Mailing Address - Phone:912-435-5453
Mailing Address - Fax:912-435-5674
Practice Address - Street 1:192 LINDQUIST ROAD
Practice Address - Street 2:BLDG 412
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31315
Practice Address - Country:US
Practice Address - Phone:912-435-5453
Practice Address - Fax:912-435-5674
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2012-08-13
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant