Provider Demographics
NPI:1255030722
Name:O'NEILL, KEVIN (FNP)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 W PEACHTREE ST NW APT 315
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-4726
Mailing Address - Country:US
Mailing Address - Phone:727-534-1714
Mailing Address - Fax:
Practice Address - Street 1:145 15TH ST NE STE 103
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3535
Practice Address - Country:US
Practice Address - Phone:470-968-6035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN299054163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse