Provider Demographics
NPI:1831581107
Name:ROYAL, KYUNG (NP)
Entity type:Individual
Prefix:
First Name:KYUNG
Middle Name:
Last Name:ROYAL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:ROYAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:1920 CHERRY LAUREL CT
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-8566
Mailing Address - Country:US
Mailing Address - Phone:770-971-4021
Mailing Address - Fax:
Practice Address - Street 1:304 TURNER MCCALL BLVD SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-5621
Practice Address - Country:US
Practice Address - Phone:706-509-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN207612363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily