Provider Demographics
NPI:1518769884
Name:WILBURN, KIARA (NP)
Entity type:Individual
Prefix:
First Name:KIARA
Middle Name:
Last Name:WILBURN
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:KIARA
Other - Middle Name:
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6612
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-6612
Mailing Address - Country:US
Mailing Address - Phone:478-250-1325
Mailing Address - Fax:
Practice Address - Street 1:1425 GEORGIA AVE STE 201A
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-6546
Practice Address - Country:US
Practice Address - Phone:478-250-1325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN278037363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily