TRICIA ELLEN MOGA KELLUM

MARTINEZ, GA
NPI1700506565
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: GA  287482)
Additional Taxonomies163W00000X Registered Nurse
(Licence: WA  61240711)
163W00000X Registered Nurse
(Licence: GA  287482)
Enumeration Date2022-08-31
Last Update Date2024-11-07
Business Address
TRICIA ELLEN MOGA KELLUM NP
519 BLACKBURN DR STE 523
MARTINEZ, GA 30907-8202
Phone number: 706-524-7134
Mailing Address
TRICIA ELLEN MOGA KELLUM NP
519 BLACKBURN DR STE 523
MARTINEZ, GA 30907-8202
Phone number: 313-463-0399