Healthcare Provider Details

I. General information

NPI: 1861406456
Provider Name (Legal Business Name): JAMES S SRP CNS, CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25010 CHAGRIN BLVD STE 100
BEACHWOOD OH
44122
US

IV. Provider business mailing address

25010 CHAGRIN BLVD STE 100
BEACHWOOD OH
44122
US

V. Phone/Fax

Practice location:
  • Phone: 216-468-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN203695
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN203695
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN.CNP.08037
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: