Provider Demographics
NPI:1558970608
Name:NATSON, KIMBERLY LA'SAE (NP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LA'SAE
Last Name:NATSON
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SUCCESS CT
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0914
Mailing Address - Country:US
Mailing Address - Phone:706-631-8016
Mailing Address - Fax:
Practice Address - Street 1:4246 WASHINGTON RD STE 8
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3345
Practice Address - Country:US
Practice Address - Phone:762-218-5328
Practice Address - Fax:631-350-0321
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA215610363LP0808X
GARN203133363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health