Provider Demographics
NPI:1184472409
Name:PERNICE, KARA (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:PERNICE
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 CLOVER CT
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4933
Mailing Address - Country:US
Mailing Address - Phone:864-561-7382
Mailing Address - Fax:
Practice Address - Street 1:4800 OLDE TOWNE PKWY STE 350
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4396
Practice Address - Country:US
Practice Address - Phone:470-648-6393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN221812163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant