Provider Demographics
NPI:1992856421
Name:KYSER, MARY ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANN
Last Name:KYSER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1148 HIRAM DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-6600
Mailing Address - Country:US
Mailing Address - Phone:770-963-2562
Mailing Address - Fax:
Practice Address - Street 1:3005 LENORA CHURCH RD
Practice Address - Street 2:BLDG. A
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3688
Practice Address - Country:US
Practice Address - Phone:770-979-9157
Practice Address - Fax:770-979-7767
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN032522163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult