Provider Demographics
NPI:1053909440
Name:KEGLER, JANICE
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:KEGLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3315 WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-2158
Mailing Address - Country:US
Mailing Address - Phone:229-376-8011
Mailing Address - Fax:
Practice Address - Street 1:3315 WESTGATE DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31721-2158
Practice Address - Country:US
Practice Address - Phone:229-376-8011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-02
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0030022517376K00000X, 3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376K00000XNursing Service Related ProvidersNurse's Aide