Provider Demographics
NPI:1154876514
Name:OUDKERK, MARCIA (FNP)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:OUDKERK
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 1:4201 OAK FIELD DR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-8175
Mailing Address - Country:US
Mailing Address - Phone:347-935-2026
Mailing Address - Fax:
Practice Address - Street 1:4201 OAK FIELD DR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-8175
Practice Address - Country:US
Practice Address - Phone:347-935-2026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF344225363LF0000X
GARN202357363LF0000X, 163WH0200X, 163WC0400X, 163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WH1000XNursing Service ProvidersRegistered NurseHospiceGroup - Multi-Specialty