1154415586 NPI number — JUDITH C KERR ANP

Table of content: JUDITH C KERR ANP (NPI 1154415586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154415586 NPI number — JUDITH C KERR ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KERR
Provider First Name:
JUDITH
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ANP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154415586
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 BRAMHALL ST, STE 2103C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04102-3134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-662-2934
Provider Business Mailing Address Fax Number:
207-662-6389

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
887 CONGRESS ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-774-2381
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2006

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: 363LA2200X , with the licence number:  R040836 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 292220099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com