Provider Demographics
NPI:1366739021
Name:COOKS, KERENSA A (RN)
Entity type:Individual
Prefix:
First Name:KERENSA
Middle Name:A
Last Name:COOKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 MIKE PADGETT HIGHWAY
Mailing Address - Street 2:SERENITY BEHAVIORAL HEALTH SYSTEMS
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906
Mailing Address - Country:US
Mailing Address - Phone:706-432-7893
Mailing Address - Fax:
Practice Address - Street 1:3421 MIKE PADGETT HIGHWAY
Practice Address - Street 2:SERENITY BEHAVIORAL HEALTH SYSTEMS
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906
Practice Address - Country:US
Practice Address - Phone:706-432-7893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN160846163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000606317BMedicaid
GA000606317BMedicaid