KETHIA SHANELLE WASHINGTON (NPI# 1376891267) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376891267 |
| Entity Type | Individual |
| Full Name | KETHIA SHANELLE WASHINGTON |
| Other Name | KETHIA MOULTRIE |
| Credential | NP |
| Practice Address |
985 Taylor St Sw Conyers GA 30012-5357 |
| Mailing Address |
2570 Riverside Pkwy P. O. Box 897 Lawrenceville GA 30046-3339 |
| Practice Telephone | 7707854345 |
| Mailing Telephone | 6784426884 |
| Mailing Fax Number | 7703394297 |
| Enumeration Date | 2012-08-27 |
| Last Update Date | 2019-12-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 204948 | GA | Nursing Service Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
RN204948 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 000456486A | 05 |
| Street Address |
985 TAYLOR ST SW |
| City | CONYERS |
| State | GA |
| Zip Code | 30012-5357 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215285101 | Camille Clarke | Licensed Practical Nurse | 985 Taylor St Sw, Conyers, GA 30012-5357 | 2012-08-27 |
| 1285103499 | Gaynor Powell | Nurse Practitioner | 985 Taylor St Sw, Conyers, GA 30012-5357 | 2018-11-16 |
| 1689922544 | Kristen Cranford | Registered Nurse | 985 Taylor St Sw, Conyers, GA 30012-5357 | 2012-08-27 |
| 1396093282 | Magan Maddox | Licensed Practical Nurse | 985 Taylor St Sw, Conyers, GA 30012-5357 | 2012-08-27 |
| 1134477029 | Shontell Robbins | Nurse Practitioner | 985 Taylor St Sw, Conyers, GA 30012-5357 | 2012-08-27 |
| 1568710457 | Toni-marie Partridge | Registered Nurse | 985 Taylor St Sw, Conyers, GA 30012-5357 | 2012-08-27 |
| 1750639647 | Elizabeth Gonzales | Licensed Practical Nurse | 985 Taylor St Sw, Conyers, GA 30012-5357 | 2012-08-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578188306 | The Eye Md | Ophthalmology | 1359 Milstead Road, Suite #103, Conyers, GA 30012 | 2020-06-08 |
| 1043855836 | Maurvet Minto | Counselor | 1175 Green St, Conyers, Conyers, GA 30012 | 2019-11-15 |
| 1770054561 | Sarah Elizabeth Brooks | Physical Medicine & Rehabilitation | 1290 Milstead Ave Ne, Conyers, GA 30012 | 2018-12-06 |
| 1679091276 | Valorie Antoinette Jones | Counselor | 1175 Green St Se, Conyers, GA 30012 | 2017-09-02 |
| 1558886341 | Synergy Radiology, LLC | Radiology | 1501 Milstead Road, Suite 140, Conyers, GA 30012 | 2017-08-14 |
| 1558813295 | Salon Lyon, LLC | Specialist | 1112 West Ave, Se, B, Conyers, GA 30012 | 2016-10-28 |
| 1992252753 | Traci Hunter Bryan | Pharmacist | 1501 Milstead Ave Ne, Suite 110, Conyers, GA 30012 | 2016-09-08 |
| 1316491830 | Hye Rim Kim | Anesthesiologist Assistant | 1380 Milstead Rd Ne, Suite G, Conyers, GA 30012 | 2016-08-12 |
| 1235591397 | David Jeffrey Wasserman | Optometrist | 1192 Dogwood Dr Sw, Conyers, GA 30012 | 2016-03-28 |
| 1174919187 | Anique Archer | Health Educator | 2170 Lester Rd Nw, Conyers, GA 30012 | 2015-04-07 |
| Find all providers in zip 30012 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760082283 | Helen King-cox | Nurse Practitioner | 1650 Honey Creek Cmns Se, Conyers, GA 30013-5831 | 2020-10-26 |
| 1982202644 | Kathy Delaine Reid | Nurse Practitioner | 2324 Wilson Rd Nw, Conyers, GA 30012-2720 | 2020-10-15 |
| 1720606437 | Natalie Shelton | Nurse Practitioner | 1950 Lancaster Dr Se, Conyers, GA 30013-6442 | 2020-07-09 |
| 1013561323 | Assumpta Ogbedeagu | Nurse Practitioner | 2920 Highway 138 Ne, Conyers, GA 30013-1110 | 2019-07-25 |
| 1528611522 | Danyelle M Smith | Nurse Practitioner | 1755 Parker Rd Se Ste A120, Conyers, GA 30094-6665 | 2019-07-18 |
| 1013475110 | Cecelin E Fields | Nurse Practitioner | 1706 Woodstone Cv Se, Conyers, GA 30013-6303 | 2019-03-07 |
| 1851858914 | Moun E. Thomas | Nurse Practitioner | 2405 Hyde Park Ct, Conyers, GA 30013-7434 | 2019-02-25 |
| 1972075919 | Candice Mooyin | Nurse Practitioner | 1506 Klondike Rd Sw Ste 250, Conyers, GA 30094-5173 | 2018-12-31 |
| 1801362140 | Linda M Leiser | Nurse Practitioner | 1066 Plantation Blvd Se, Conyers, GA 30094-4120 | 2018-10-14 |
| 1356822126 | Glory Dioh-esona | Nurse Practitioner | 2340 Deeside Se, Conyers, GA 30013-6470 | 2018-08-28 |
| Find all providers in CONYERS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.