MYRA SAMPLE (NPI# 1659828283) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659828283 |
| Entity Type | Individual |
| Full Name | MYRA SAMPLE |
| Credential | LPN |
| Practice Address |
2711 Highland Ridge Kennesaw GA 30152-6028 |
| Practice Telephone | 4847690338 |
| Mailing Telephone | 4847690338 |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2016-09-01 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 164W00000X | Licensed Practical Nurse | PN293099 | PA | Nursing Service Providers |
| Y | 164W00000X | Licensed Practical Nurse | LPN089826 | GA | Nursing Service Providers |
| Street Address |
2711 HIGHLAND RIDGE |
| City | KENNESAW |
| State | GA |
| Zip Code | 30152-6028 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821647124 | Ashley Dover | Nurse Practitioner | 1300 Ridenour Blvd, Suite 300, Kennesaw, GA 30152 | 2019-09-09 |
| 1205306891 | Lashanda Denise Moore | Nurse Practitioner | 1600 Kennesaw Due West Rd Nw #205, Kennesaw, GA 30152 | 2018-11-27 |
| 1265901094 | Focused Loving Home Care Services LLC | In Home Supportive Care | 2151 Marne Glen Nw, Kennesaw, GA 30152 | 2018-11-22 |
| 1083199152 | Raven Ashley Thomas | Behavioral Analyst | 1619 Collins Rd Nw Ste 500, Kennesaw, GA 30152 | 2018-09-25 |
| 1821592593 | Eseovhe Egborge PC | Clinic/Center | 1600 Kennesaw Due West Rd Nw Ste 205, Kennesaw, GA 30152 | 2018-03-19 |
| 1184143059 | Kennesaw Mountain Dental Associates | Dentist | 1815 Old 41 Hwy, Ste 310, Kennesaw, GA 30152 | 2017-09-12 |
| 1265955983 | Deborah Ruth Stern Compton | Registered Nurse | 1291 Stanley Rd., Kennesaw, GA 30152 | 2017-07-25 |
| 1912452939 | Mak Anesthesia Holdings LLC | Anesthesiology | 1300 Ridenour Blvd., Ste. 300, Kennesaw, GA 30152 | 2016-08-19 |
| 1528430279 | Tineka Nichol Wyckoff | Counselor | 1967 Lake Heights Circle, Kennesaw, GA 30152 | 2015-10-21 |
| 1669753992 | American Current Care Pa | Clinic/Center | 2953 Cobb Parkway, Suite 400, Kennesaw, GA 30152 | 2011-08-31 |
| Find all providers in zip 30152 | ||||
| Taxonomy Code | 164W00000X |
| Grouping | Nursing Service Providers |
| Classification | Licensed Practical Nurse |
| An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states. |
| Notes: Source: Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457671968 | Zettia Barney | Licensed Practical Nurse | 1667 Heyford Cir Nw, Kennesaw, GA 30152-7632 | 2010-06-07 |
| 1053899815 | Byrunis Earl Mays Jr. | Licensed Practical Nurse | 1291 Stanley Rd Nw, Kennesaw, GA 30152-4359 | 2018-08-03 |
| 1801374665 | Rubynell Brown | Licensed Practical Nurse | 1291 Stanley Rd Nw, Kennesaw, GA 30152-4359 | 2018-08-03 |
| 1265910020 | Deana Paula Cilento | Licensed Practical Nurse | 1291 Stanley Rd Nw, Kennesaw, GA 30152-4359 | 2018-08-03 |
| 1265950653 | Dawn Michelle Smart | Licensed Practical Nurse | 1291 Stanley Rd., Kennesaw, GA 30152 | 2017-09-06 |
| 1295255206 | Holland Emra | Licensed Practical Nurse | 1291 Stanley Rd Nw, Kennesaw, GA 30152-4359 | 2017-06-21 |
| 1215457270 | Trevor George | Licensed Practical Nurse | 1291 Stanley Rd Nw, Kennesaw, GA 30152-4359 | 2017-06-21 |
| 1689194698 | Pamela Maples | Licensed Practical Nurse | 1291 Stanley Rd Nw, Kennesaw, GA 30152-4359 | 2017-06-21 |
| 1609396647 | Stacey Warren | Licensed Practical Nurse | 1291 Stanley Rd Nw, Kennesaw, GA 30152-4359 | 2017-06-21 |
| 1598285546 | Dianne Davis | Licensed Practical Nurse | 1291 Stanley Rd Nw, Kennesaw, GA 30152-4359 | 2017-06-21 |
| Find all providers in KENNESAW | ||||
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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.