Provider Demographics
NPI:1265115018
Name:SEAGLE, KIERSTEN (LPN)
Entity type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:
Last Name:SEAGLE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KIERSTEN
Other - Middle Name:
Other - Last Name:LANIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:649 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-3770
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:230 RIVERSTONE PKWY STE C
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-6414
Practice Address - Country:US
Practice Address - Phone:470-863-6370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN098140164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse