Provider Demographics
NPI:1689661308
Name:CSEREP, BARBARA KAY (RN,CPNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:KAY
Last Name:CSEREP
Suffix:
Gender:F
Credentials:RN,CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 JON JUCA CT
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-3409
Mailing Address - Country:US
Mailing Address - Phone:770-498-8014
Mailing Address - Fax:
Practice Address - Street 1:146 W ATHENS ST
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-1707
Practice Address - Country:US
Practice Address - Phone:678-425-0605
Practice Address - Fax:678-425-0636
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN072332363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics