Provider Demographics
NPI:1972114502
Name:WEATHERFORD, KIMBERLEY DAWN BEASLEY (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:DAWN BEASLEY
Last Name:WEATHERFORD
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12938
Mailing Address - Street 2:C/O CLINIC MANAGEMENT
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703
Mailing Address - Country:US
Mailing Address - Phone:706-602-7800
Mailing Address - Fax:
Practice Address - Street 1:2112 SHORTER AVE NW STE 200
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2042
Practice Address - Country:US
Practice Address - Phone:706-233-4000
Practice Address - Fax:706-236-1913
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN246435363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily