Provider Demographics
NPI:1164697355
Name:KANCLERZ, JOSEPH HENRY (MSN, NP-C, RNFA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:HENRY
Last Name:KANCLERZ
Suffix:
Gender:M
Credentials:MSN, NP-C, RNFA
Other - Prefix:
Other - First Name:JOEY
Other - Middle Name:
Other - Last Name:KANCLERZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN, NP-C, RNFA
Mailing Address - Street 1:PO BOX 7042
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30502-0042
Mailing Address - Country:US
Mailing Address - Phone:678-591-8344
Mailing Address - Fax:
Practice Address - Street 1:5742 ALLEE WAY
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-6268
Practice Address - Country:US
Practice Address - Phone:678-591-8344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN177592163WR0006X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant