KELLY WIEDOWER
NPI 1629528450
Nurse Practitioner - Family in Greensboro, GA

Q: What is Kelly Wiedower's NPI number?

The NPI number for Kelly Wiedower is 1629528450. It was assigned to this individual provider in the NPPES registry on October 5, 2016.

Q: What is Kelly Wiedower's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Kelly Wiedower was last updated on October 5, 2016. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since October 05, 2016

1041 PARK DR, GREENSBORO, GA 30642(706) 453-4945 Get Directions Write a Review

NPPES record last updated: October 5, 2016. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Kelly Wiedower NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY WIEDOWER (NPI 1629528450) is an individual family provider in Greensboro, Georgia, licensed in Georgia (213342) and active in the NPI registry since October 2016.

NPPES Registry Identity

NPI1629528450

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameKELLY WIEDOWER

Location Address1041 PARK DRGreensboro, GA 30642-3465

Mailing Address1081 Princeton LnWatkinsville, GA 30677-5338 · (706) 254-3250

Phone(706) 453-4945

Sole ProprietorNo

Enumeration DateOctober 5, 2016

✔ NPI 1629528450 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in GA · 213342

1041 PARK DR, Greensboro, GA 30642

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Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PERFORMANCE CHIROPRACTIC & WELLNESS

Clinic/Center