1144696931 NPI number — MRS. KERRI JEAN MCANULTY CRNP

Table of content: MRS. KERRI JEAN MCANULTY CRNP (NPI 1144696931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144696931 NPI number — MRS. KERRI JEAN MCANULTY CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCANULTY
Provider First Name:
KERRI
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOODLIN
Provider Other First Name:
KERRI
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
KERRI JEAN MCDANIEL
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144696931
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 MARGARET AVE STE 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JEANNETTE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15644-3081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-522-5456
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 MARGARET AVE STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEANNETTE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15644-3081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-522-5456
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  SP014828 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)