Provider Demographics
NPI:1902879901
Name:SHORT, KERRY LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:LYNN
Last Name:SHORT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4001 KRESGE WAY
Mailing Address - Street 2:315
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4640
Mailing Address - Country:US
Mailing Address - Phone:502-897-7416
Mailing Address - Fax:502-895-6638
Practice Address - Street 1:4001 KRESGE WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4640
Practice Address - Country:US
Practice Address - Phone:502-897-7416
Practice Address - Fax:502-895-6638
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY209652088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64209653Medicaid
KY64209653Medicaid
KY1879502Medicare PIN