Provider Demographics
NPI:1265196687
Name:KAMARA, ROSALINE
Entity type:Individual
Prefix:
First Name:ROSALINE
Middle Name:
Last Name:KAMARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 MISTY VIEW TRL
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-1894
Mailing Address - Country:US
Mailing Address - Phone:678-234-6154
Mailing Address - Fax:
Practice Address - Street 1:3024 MISTY VIEW TRL
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-1894
Practice Address - Country:US
Practice Address - Phone:678-234-6154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN166570363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily