Provider Demographics
NPI:1881970879
Name:IKPE, CHARITY NNENNA (FNP)
Entity type:Individual
Prefix:MRS
First Name:CHARITY
Middle Name:NNENNA
Last Name:IKPE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2692 TRELLIS OAKS CT SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-5407
Mailing Address - Country:US
Mailing Address - Phone:770-444-3915
Mailing Address - Fax:
Practice Address - Street 1:3545 CRUSE RD STE 103
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-3169
Practice Address - Country:US
Practice Address - Phone:770-456-5666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-23
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN171431363LF0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily