Provider Demographics
NPI:1144525940
Name:PAULK, KERI ANN (CRNA)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:ANN
Last Name:PAULK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KERI
Other - Middle Name:ANN
Other - Last Name:YANOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:62 SUGAR CREEK LN
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-3784
Mailing Address - Country:US
Mailing Address - Phone:229-646-1348
Mailing Address - Fax:
Practice Address - Street 1:901 GRIFFIN AVE
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6720
Practice Address - Country:US
Practice Address - Phone:478-448-4020
Practice Address - Fax:478-448-4020
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9236806367500000X
GARN212553367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003105271AMedicaid
FL0031395-00Medicaid
GA003105271AMedicaid