KELLY TICKLE PCNS-BC PPCNP-BC NPI 1417379538

NPI Information

  • NPI: 1417379538
  • Provider Name: KELLY TICKLE, PCNS-BC, PPCNP-BC
  • Classification: Nurse Practitioner - 363LP0200X
  • Specialization: Pediatrics
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 5455 MERIDIAN MARKS RD STE 400
    ATLANTA, GA
    ZIP 30342
  • Phone: (404) 785-3240

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NPI Details

Kelly Tickle, PCNS-BC, PPCNP-BC is a pediatrics nurse practitioner in Atlanta, GA. Kelly Tickle, PCNS-BC, PPCNP-BC NPI is 1417379538. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

5455 MERIDIAN MARKS RD STE 400
ATLANTA, GA
ZIP 30342-723
Phone: (404) 785-3240
Fax: (404) 785-3600

The NPI 1417379538 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/8/2014 and was last updated on 1/8/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LP0200XNurse PractitionerPediatricsRN228738GEORGIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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