Keandrea Bacon, is a
Nurse Anesthetist, Certified Registered based in Ellenwood, Georgia. Keandrea Bacon is licensed to practice in Georgia (license number CRNA233963) and her current practice location is
120 Whirlaway Dr, Ellenwood, Georgia. She can be reached at her office (for appointments etc.) via phone at
(404) 444-3887.
NPI number for Keandrea Bacon is 1619712676 and her current mailing address is 120 Whirlaway Dr, Ellenwood, Georgia. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1619712676.
Provider's Profile
| Full Name | Keandrea Bacon |
|---|
| Gender | Female |
|---|
| Speciality | Nurse Anesthetist, Certified Registered |
|---|
| Location | 120 Whirlaway Dr, Ellenwood, Georgia |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1619712676
- Provider Enumeration Date: 07/01/2024
- Last Update Date: 09/23/2025
Medical Identifiers
Medical identifiers for Keandrea Bacon such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1619712676 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 367500000X | Nurse Anesthetist, Certified Registered | CRNA233963 (Georgia) | Primary |
| 163W00000X | Registered Nurse | RN233963 (Georgia) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Keandrea Bacon is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Keandrea Bacon,
120 Whirlaway Dr,
Ellenwood, GA 30294-3259
Ph: (404) 444-3887 | Keandrea Bacon,
120 Whirlaway Dr,
Ellenwood, GA 30294-3259
Ph: (404) 444-3887 |
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