Provider Demographics
NPI:1669234506
Name:STOVALL, KINSEY BROOKE (NP)
Entity type:Individual
Prefix:
First Name:KINSEY
Middle Name:BROOKE
Last Name:STOVALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 ALSTON ST STE A
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31825-6012
Mailing Address - Country:US
Mailing Address - Phone:229-887-3324
Mailing Address - Fax:
Practice Address - Street 1:510 ALSTON ST STE A
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:GA
Practice Address - Zip Code:31825-6012
Practice Address - Country:US
Practice Address - Phone:229-887-3324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN279410363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily