1457983199 NPI number — MRS. KATELYN ALYSE KERR MA, NCC

Table of content: MRS. KATELYN ALYSE KERR MA, NCC (NPI 1457983199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457983199 NPI number — MRS. KATELYN ALYSE KERR MA, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KERR
Provider First Name:
KATELYN
Provider Middle Name:
ALYSE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TUCKER
Provider Other First Name:
KATELYN
Provider Other Middle Name:
ALYSE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA NCC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457983199
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
793 OLD ROUTE 119 HWY NORTH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-465-5576
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
793 OLD ROUTE 119 HWY NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-465-5576
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/11/2020

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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