Provider Demographics
NPI:1861406456
Name:SRP, JAMES S (CNS, CNP)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:S
Last Name:SRP
Suffix:
Gender:M
Credentials:CNS, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25010 CHAGRIN BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25010 CHAGRIN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-468-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN203695363L00000X, 364SP0809X
OHAPRN.CNP.08037364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH364039OtherWELLCARE MEDICAID
OH000000224400OtherUNISON
OH2834866Medicaid
OH7942656OtherAETNA
OH000000533028OtherANTHEM
OHSRNS03041Medicare PIN
Q34877Medicare UPIN
OH000000224400OtherUNISON