Provider Demographics
NPI:1487890349
Name:KEMP, KELDA MARIE (RN, MSN, ACNP-BC)
Entity type:Individual
Prefix:
First Name:KELDA
Middle Name:MARIE
Last Name:KEMP
Suffix:
Gender:F
Credentials:RN, MSN, ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5636 GRIST STONE DR SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-6231
Mailing Address - Country:US
Mailing Address - Phone:770-381-1574
Mailing Address - Fax:
Practice Address - Street 1:5636 GRIST STONE DR SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-6231
Practice Address - Country:US
Practice Address - Phone:770-381-1574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-25
Last Update Date:2008-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA170487163W00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse