Provider Demographics
NPI:1548926041
Name:VIBERT, IESHA DOMINIQUE (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:IESHA
Middle Name:DOMINIQUE
Last Name:VIBERT
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1080 EAGLES LANDING PKWY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5012
Mailing Address - Country:US
Mailing Address - Phone:470-516-9950
Mailing Address - Fax:470-221-1821
Practice Address - Street 1:1080 EAGLES LANDING PKWY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5012
Practice Address - Country:US
Practice Address - Phone:470-516-9950
Practice Address - Fax:470-221-1821
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN244291363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health