Provider Demographics
NPI:1366636664
Name:O'BRIEN, DEIRDRE K (NP-C)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:K
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 HABERSHAM DR
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-5306
Mailing Address - Country:US
Mailing Address - Phone:912-287-1130
Mailing Address - Fax:
Practice Address - Street 1:501 W ONEIDA ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5337
Practice Address - Country:US
Practice Address - Phone:912-287-1130
Practice Address - Fax:912-287-1231
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN135235363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN135235OtherSTATE OF GEORGIA LICENSE