Provider Demographics
NPI:1912990763
Name:KENT, TINA M (NP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:KENT
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 1:1667 WAYMANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-5072
Mailing Address - Country:US
Mailing Address - Phone:706-647-5232
Mailing Address - Fax:
Practice Address - Street 1:314 E LEE ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-4122
Practice Address - Country:US
Practice Address - Phone:706-647-7148
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN073124363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAS84513Medicare UPIN