Provider Demographics
NPI:1992599203
Name:STORY, EBONY NICHOLE (PMHNP, APRN)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:NICHOLE
Last Name:STORY
Suffix:
Gender:F
Credentials:PMHNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 GARLAND TRL
Mailing Address - Street 2:
Mailing Address - City:HARLEM
Mailing Address - State:GA
Mailing Address - Zip Code:30814-5152
Mailing Address - Country:US
Mailing Address - Phone:706-664-1410
Mailing Address - Fax:
Practice Address - Street 1:632 GARLAND TRL
Practice Address - Street 2:
Practice Address - City:HARLEM
Practice Address - State:GA
Practice Address - Zip Code:30814-5152
Practice Address - Country:US
Practice Address - Phone:706-699-7139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN233862163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse