Provider Demographics
NPI:1922760131
Name:BISCAN, KIMBERLY CHRISTINA (NP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CHRISTINA
Last Name:BISCAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1743 WATSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3622
Mailing Address - Country:US
Mailing Address - Phone:478-929-2909
Mailing Address - Fax:
Practice Address - Street 1:1743 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3622
Practice Address - Country:US
Practice Address - Phone:478-929-2909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN250388363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA206293430Medicaid
GAG206293430Medicaid