Provider Demographics
NPI:1689462442
Name:HEARD, KIA
Entity type:Individual
Prefix:MRS
First Name:KIA
Middle Name:
Last Name:HEARD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KIA
Other - Middle Name:
Other - Last Name:NALLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 BOMBAY LANE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076
Mailing Address - Country:US
Mailing Address - Phone:770-754-4674
Mailing Address - Fax:
Practice Address - Street 1:601 BOMBAY LANE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076
Practice Address - Country:US
Practice Address - Phone:770-754-4674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN072189164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse