Bacon, Keandrea

Bacon, Keandrea is an sole proprietor health care provider with primary practice located at 120 Whirlaway Dr , Ellenwood GA 30294-3259. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, Nursing Service Providers / Registered Nurse. Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered is her primary health care specialty. Bacon, Keandrea can be contacted via phone (404) 444-3887.

Contact Information

Primary practice address
120 Whirlaway Dr Ellenwood GA 30294-3259
Phone: (404) 444-3887
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X CRNA233963 Georgia
Nursing Service Providers / Registered Nurse 163W00000X RN233963 Georgia

Profile Details

NPI number 1619712676
LBN Legal business name Bacon, Keandrea
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 1st, 2024
Last updated Sep 23rd, 2025 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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