Provider Demographics
NPI:1053876714
Name:MYERS, AUDRA KATHLEEN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:AUDRA
Middle Name:KATHLEEN
Last Name:MYERS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1078 LUMPKIN CAMPGROUND RD S
Mailing Address - Street 2:STE 100
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-0988
Mailing Address - Country:US
Mailing Address - Phone:770-709-6922
Mailing Address - Fax:
Practice Address - Street 1:810 PINE ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-6754
Practice Address - Country:US
Practice Address - Phone:770-503-1369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN239189363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily