Healthcare Provider Details

I. General information

NPI: 1689661308
Provider Name (Legal Business Name): BARBARA KAY CSEREP RN,CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 W ATHENS ST
WINDER GA
30680-1707
US

IV. Provider business mailing address

1418 JON JUCA CT
STONE MOUNTAIN GA
30088-3409
US

V. Phone/Fax

Practice location:
  • Phone: 678-425-0605
  • Fax: 678-425-0636
Mailing address:
  • Phone: 770-498-8014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN072332
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: